Poster Abstracts

200 | Clinicians’ and patients’ knowledge, understanding and communication related to biomarkers in cancer care: A systematic review

Rehana Abdus Salam^1,2, Andrea Smith¹, Kate L.A. Dunlop¹, Tuba Gide^2,3, James Wilmott^2,3, Anne E. Cust^1,2

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

²Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

³Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia

Aims: Clinicians and patients face distinct challenges related to the role and value of biomarker testing to inform personalised prognosis and treatment in cancer care. We aimed to synthesise evidence on clinicians’ and patients’ knowledge, understanding and communication along with associated factors related to the use of biomarker testing using the theoretical domains framework.

Method: We searched MEDLINE, EMBASE, Web of Science Index Medicus, CINAHL, Lilacs, CENTRAL (Cochrane Library) and Google Scholar until July 2024. Studies assessing knowledge, understanding and communication or associated factors related to biomarkers in cancer care among clinicians and patients were included.

Results: A total of 80 studies were included: 50 quantitative, 26 qualitative, and four mixed methods studies. Thirty-nine studies reported clinician-related outcomes (33 reported clinician knowledge and 15 reported communication); 24 studies reported patient-related outcomes (20 reported patient knowledge and 19 reported communication); and 23 studies reported associated factors. Clinicians had inconsistent knowledge and limited skills related to interpreting biomarker test results and communicating findings of uncertainty and its implications for patients. Lack of expert consensus and clinical guidelines for biomarker testing led to uncertainties. Excessive turn-around times, lack of insurance coverage, and logistical requirements hindered implementation. Patients highlighted the need for more information about biomarker testing and its potential benefits but were optimistic about contributing to research even if it was unlikely to provide them with personal benefits. Expectations of benefits to patients from biomarker testing did not always align with the probability of successful outcome.

Conclusion: This review highlights gaps in knowledge and communication related to biomarker testing in cancer care. Owing to the complex and evolving scope of biomarker testing, additional training to improve knowledge and communication skills are crucial. Future strategies should be targeted towards reducing uncertainties including setting up institutional guidelines and multi-disciplinary team coordination for shared decision making.

201 | Clinical and pathological significance of cancer stem cells markers

Reem A.L. Hulais¹, Stephen Ralph¹

¹School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia

Studies have shown that a subpopulation of cells known as cancer stem cells (CSCs) exist within tumours and are proposed to be the underlying cause of efficient tumour metastasis. Although this malignant colon cancer cell population is estimated to typically account for 9 percent or less of the cells in tumours, only some of these cells have the capacity to form new tumours. To advance therapeutic approaches targeting CSCs, it is important to study them using the cell surface markers that identify them. This study focused on identifying the relationship between the CSC markers ABGC2, Cripto-1, CD271, EPCAM, OCT4 or SSEA1 and pathology samples derived from human colorectal cancer (CRC) patients.

Surgically excised CRC pathology samples were categorised by immunohistochemistry as either negative, low positive, positive or high positive regions of staining within the defined tumour sections. The different types of colorectal cancers, including polyps (n = 10), primary adenocarcinoma (n = 20) or metastatic groups (n = 20), were categorised and immunostained and, in some cases, compared to the adjacent normal colon with antibodies against ABGC2, Cripto-1, CD271, EPCAM, OCT4 or SSEA1. The percentages of negative, weakly positive, positive and highly positive stained regions as a proportion of the total area from each of the patient's cancer samples were compared to each other and were then averaged across the same sample types using the methods for quantifying immunostaining.

In summary, the analysis of the putative CSC markers was identified to confirm the low level of expression of these markers within tumour sections from the primary tumour samples of human CRC patients. Interestingly, the levels of highly positive expression were obtained in the more advanced metastatic tumour samples, with co-expression as a common finding suggesting that they are involved in the CSC phenotype.

204 | Prevalence and co-mutation status of MTAP deletions

Samuel Harris^1,2, Vincent Caillet¹, Amy Davies¹, Greg Gaughran^1,3, Christine Napier^1,4, Frank Lin¹, John Simes^1,4, John Grady^1,4, Mandy Balinger^1,4, David Thomas^1,4

¹Omico: Australian Genomic Cancer Medicine Centre, Syndey, NSW, Australia

²Bendigo Health, Bendigo, VIC, Australia

³University Hospital, Geelong, VIC, Australia

⁴Centre for Molecular Oncology, Sydney, NSW, Australia

Aims: MTAP deletion is an emerging target for MAT2A and PRMT5 inhibitors. We aim to describe the prevalence and other characteristics of MTAP deletions in the OMICO CaSP/MoST population.

Methods: MoST and CaSP are screening programs enrolling patients with advanced cancers for molecular sequencing. MTAP deletion was assessed directly by Foundation Medicine & Avenio (FMI&A) and indirectly by TSO500 via analysis of background reads adjacent to CDKN2A. We report prevalence across both platforms, cancer primary site and co-mutations. Kaplan–Meier survival analysis was performed to assess prognostic value of MTAP.

Results: 686/8,926 (7.7%) were found to have MTAP deletions. 497/3698 (13.4%) were identified using FMI&A, 189/5238 (3.6%) using the TSO500. Table 1 shows most common tumours with MTAP deletions. Deletions were rare in colorectal (1%), gynaecological (3%) and prostate cancers (0.8%). MTAP deletion was associated with significantly worse median survival in pancreas cancer (9.1 vs. 13 m; HR 0.60 [95% CI 0.52–0.69]; p < 0.001) but there were no statistically differences detected in survival for other cancers. In the FMI&A datasets 86% of pts had codeletion of CDKN2A. TP53, KRAS and EGFR co-alterations were the next most common. Activating co-alterations in EGFR, KRAS and ALK were frequently seen in lung cancers.

Conclusions: MTAP deletions are common in the MoST/CaSP population, most frequently in CNS, pancreas, lung and melanoma patients. Detection of MTAP deletion was higher with the FM1&A platform. MTAP deletions co-existed with CDKN2A deletions in >80% of the cohort. Other targetable mutations were also found to co-occur. MTAP deletions may be associated with worse survival in pancreatic cancer.

205 | Discovery of DYRK1A inhibitors as potential treatment of pancreatic ductal adenocarcinoma (PDAC)

Hsing-Pang Hsieh¹, Yu-Xiang Zhang-Jian¹, Kai-Cheng Hsu², Shiow-Lin Pan², Wen-Shan Li^3,4, Han-Chung Wu^4,5

¹Institute of Biotech and Pharma Research, National Health Research Institutes, Miaoli County, Taiwan

²Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan

³Institute of Chemistry, Academia Sinica, Taipei, Taiwan

⁴Biomedical Translation Research Center (BioTReC), Academia Sinica, Taipei, Taiwan

⁵Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan

Dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A) belongs to the CMGC family of eukaryotic protein kinases and is an attractive therapeutic target due to its roles in both neurodegenerative diseases and cancers. Based on the activity of DYRK1A interactors and substrates, it is assumed that DYRK1A is a pleiotropic protein with widespread cellular functions, including the regulation of cell proliferation, survival, and differentiation.

In a recent study, DYRK1A was shown to be upregulated in pancreatic ductal adenocarcinoma (PDAC), providing evidence that DYRK1A favours tumour progression. In a PANC-1-shDYRK1A xenograft animal model, reduced levels of DYRK1A impaired proliferation, leading to slower tumour progression. These results prompted the discovery of DYRK1A inhibitors for the treatment of PDAC.

In this study, we designed and synthesized a series of DYRK1A inhibitors. The structure–activity relationship (SAR) study results showed that PANDK103 exhibited excellent DYRK1A inhibitory ability with an IC50 value of 7.8 nM, 40-fold greater than INDY, the known reference compound. Currently, we have achieved acceptable pharmacokinetic data. Further hit-to-lead optimization and pharmacokinetics studies are in progress and will be reported in due course.

Reference:

1. Jarhad DB, Mashelkar KK, Kim H-R, Noh M, Jeong LS. Dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A) inhibitors as potential therapeutics. J Med Chem. 2018;61:9791-9810.

206 | Novel approach to anti-tumour and anti-SARS-COV-2 drugs by modulating sialylation of N-glycans

Wen-Shan Li¹, Ser John L. Perez², Tzu-Ting Chang³, Chia-Ling Chen², Shih-Han Wang⁴, Chia-Wei Li⁴, Hsing-Pang Hsieh⁵, Han-Chung Wu⁶

¹Institute of Chemistry, Academia Sinica, Taipei, Taiwan

²Sustainable Chemical Science and Technology Program, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan

³Biomedical Translational Research Center, Academia Sinica, Taipei, Taiwan

⁴Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan

⁵Institute of Biotech and Pharma Research, National Health Research Institutes, Miaoli County, Taiwan

⁶Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan

Variations in cell surface sialylation are known to play an important role in tumour cell invasion and metastasis. Modifications of sialylation in vivo are mediated by several glycoprotein- and glycolipid-specific sialyltransferases (STs). At present, few selective STs inhibitors with a cell-permeable property have been documented.¹ In addition, observations of sialylated glycans, specifically glycolipids, facilitate viral entry of SARS-CoV-2 are confirmed and validated.² Thus, the discovery of anti-SARS-CoV2 agents that can target specific ST isozymes in vivo, is essential for the development of effective chemical therapeutics to prevent viral infection.

To address the scarcity of novel STs inhibitors, we now report the synthesis and biological evaluation of new and novel bishomolithocholic acid derivatives with promising therapeutic potential against breast cancer growth and SARS-CoV-2 infection. Among the series, SPP-037 preferentially inhibited the activity of ST6GAL1 (sialylation of N-glycan) with an IC₅₀ value of 3.6 µM over ST3GAL1 (IC₅₀ > 500 µM; sialylation of O-glycan)). In vitro cell-based assays revealed that SPP-037 suppressed MDA-MB-231 cell migration and HUVEC tube formation. Moreover, administration of SPP-037 to tumour-bearing mice resulted in reduced tumour growth, thereby highlighting its anticancer activity.

Furthermore, we validated that SARS-CoV-2 upregulates ST6GAL1 expression and sialylation using RT-qPCR analysis, immunohistochemistry and immunofluorescence imaging assays. It was found that treatment of A549-hACE2 cells with SPP-037 attenuated cellular sialylation, substantially decreasing SARS-CoV-2 infection. Our results underscore the feasibility of ST6GAL1 inhibition as an ingenious therapeutic intervention to suppress SARS-CoV-2 infectivity.

References:

1. Perez SJLP, Fu CW, Li WS, Sialyltransferase inhibitors for the treatment of cancer metastasis: current challenges and future perspectives. Molecules. 2021;26:5673.

2. Nguyen et al. Sialic acid-containing glycolipids mediate binding and viral entry of SARS-CoV-2, Nat Chem Biol. 2022;18:81.

207 | Improving oral health of cancer patients: dentists’ perspectives

Sheau Ling Low¹, Alex Holden^1,2, Joanne Shaw^3,4

¹The University of Sydney, Sydney, Australia

²Sydney Dental Hospital and Oral Health Services, Sydney, Australia

³Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia

⁴The University of Sydney, Sydney, NSW, Australia

Aims: Oral health issues in cancer patients often go unnoticed. This is despite studies showing dental intervention can mitigate cancer-related oral health issues and improve quality of life. This study aimed to identify barriers and facilitators to dentists’ management of cancer patients’ oral health.

Methods: This mixed-method study comprised an online survey and semi-structured telephone interviews. Dentists were eligible to participate if they were working clinically in Australia. The study included questions related to knowledge, confidence, cancer experience, perceived role and barriers/facilitators to providing oral health care. Quantitative data was analysed descriptively. Stepwise regression identified predictors of knowledge and confidence. Qualitative data was analysed thematically using a framework approach.

Results: Eighty-eight dentists completed the survey and 28 participated in interviews. 56% of participants were female, with a mean of 20 years clinical experience. 87% were general dentists, working in private practice (67%), primarily in metropolitan areas (72%). Majority of participants were confident (93%) managing cancer patients and had moderate to high cancer knowledge (86%), although only 21% reported seeing more than 10 cancer patients per year. Recent cancer continuing education (p = 0.015) predicted level of cancer knowledge, and number of cancer patients seen (p < 0.001) predicted confidence. Thematic analysis identified four themes that influenced dentists’ provision of oral care for cancer patients: (i) perceived scope of practice, (ii) clinical interest in cancer care, (iii) structure of healthcare and (iv) patient-factors influencing access to dental care.

Conclusion: Despite dentists having the knowledge and confidence, provision of oral care to cancer patients is dependent on dentists’ willingness to provide care which is influenced by their clinical interests and practice model, better integration of community and hospital-based care pathway as well as understanding the psychosocial needs of cancer patients.

209 | Evaluating the clinical utility of circulating cell-free DNA in endometrial cancer: A systematic scoping review

Eliza Macdonald¹, Grace Rose^2,3, David Simar¹, Alexandra McCarthy⁴, Caroline Ford⁵, Kristina Warton⁵, Sandi Hayes^6,7, Briana Clifford^1,8

¹School of Health Sciences, UNSW, Sydney, NSW, Australia

²School of Health, University of the Sunshine Coast, Sunshine Coast, QLD, Australia

³School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia

⁴Griffith Health Group, Griffith University, Gold Coast, QLD, Australia

⁵School of Clinical Medicine, UNSW, Sydney, NSW, Australia

⁶Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia

⁷Cancer Council Queensland, Fortitude Valley, QLD, Australia

⁸School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia

Background/Aim: Elevated concentrations of circulating cell free DNA (cfDNA) and circulating tumour DNA (ctDNA) have been identified in individuals with cancer. cfDNA is under investigation as a biomarker of clinical significance across the endometrial cancer (EC) continuum, but data are limited. The aim of this systematic scoping review is to provide an overview of studies evaluating the utility of cfDNA in EC and to describe the landscape of future cfDNA research in this context.

Methods: The review was conducted in accordance with PRISMA Scoping Reviews Guidelines and prospectively registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/6BFE7). Research databases and trials registries were searched from inception using terms related to ‘endometrial cancer’ and ‘cell-free DNA’.

Results: Seventy-three records (n = 61 studies; n = 12 trials registrations) were included. Cohorts were EC/uterine cancer (UC) (n = 26/61) or mixed (n = 35/61), containing 1 ≥ 1300 with EC/UC. cfDNA was evaluated for its utility in (1) EC diagnosis, (2) EC molecular profiling, (3) EC prognosis/risk of recurrence, and (4) monitoring EC disease status over time. cfDNA was isolated from blood (n = 60), vaginal fluid (n = 1), peritoneal wash (n = 2), uterine lavage (n = 1), and urine (n = 1). cfDNA analysis included quantification and sequencing, typically using fluorescence-based, PCR-based, and/or next generation sequencing assays. ctDNA parameters (e.g., mutation status/burden; methylation status) demonstrated superior performance to cfDNA quantity alone, in diagnosis, profiling, prognostic risk, and longitudinal monitoring. Three studies accounted for health factors, observing higher cfDNA quantity with elevated BMI and hypertension, and no difference in methylation-based assay diagnostic accuracy according to BMI.

Conclusions: cfDNA testing has potential to revolutionise minimally invasive EC diagnosis, profiling, prognostic risk assessment, and monitoring. Improving the performance of cfDNA tests and determining the influence of health/lifestyle factors on cfDNA is paramount to this. Suitably powered longitudinal studies evaluating cfDNA kinetics represent an opportunity to harness cfDNA in EC surveillance and disease risk modification.

210 | Evaluation of survivorship care plans at northeast health wangaratta

Rebecca McAllister¹, Amanda Kavanagh², Erin Primmer², Samantha Cooper²

¹Hume Regional Integrated Cancer Service, Shepparton, VIC, Australia

²Cancer & Wellness Service, Northeast Health Wangaratta, Wangaratta, VIC, Australia

Aims: This study aimed to evaluate the implementation of Survivorship Care Plans (SCPs) from the perspectives of patients and stakeholders, evaluating SCP impact on communication, coordination of post-treatment care for cancer survivors, and patient experience and satisfaction outcomes.

Conclusions: The Northeast Health Wangaratta pilot project demonstrated SCPs’ potential as transformative tools in post-treatment cancer care. Although not yet standard in Australia, SCPs at Northeast Health Wangaratta demonstrated comprehensive and coordinated survivorship care. Positive feedback from patients and healthcare professionals highlights SCPs’ role in enhancing patient experience, care coordination, and patient empowerment in their healthcare journey. Due to this success, work is currently occurring to extending the use of SCPs within the service.

211 | Cost impact of chemotherapy dose banding: A pilot analysis of six commonly prescribed drugs

Michelle Rantucci¹, Nijole Bernaitis¹

¹Icon Group, South Brisbane, QLD, Australia

Aims: The Australian Government review of the Efficient Funding of Chemotherapy (EFC) arrangement recommended introducing dose banding, but there is limited real-world Australian data on cost implications. The aim of this pilot analysis was to investigate the potential cost impact of introducing chemotherapy dose banding, through analysis of six commonly prescribed drugs.

Methods: A retrospective data extraction was conducted of orders (1/7/2023–30/10/2023) for six chemotherapy drugs, namely carboplatin, docetaxel, fluorouracil, gemcitabine, oxaliplatin and paclitaxel. A target banded dose using the National Health System England Dose Banding Tables was assign from prescribed dose. Difference between prescribed and banded dose was calculated for dose in milligrams and for vials required to compound the two doses, then the EFC review averaged price per milligram of each drug used to costs these differences.

Results: A total of 9018 orders were included in the study, with 37.2% for fluorouracil, 18.2% paclitaxel, 14.3% gemcitabine, 13.3% carboplatin, 10.9% oxaliplatin and 6.1% docetaxel. Total dose difference between prescribed and banded dose increased for each drug: fluorouracil 50030.2 mg; gemcitabine 5003.18 mg; carboplatin 2858 mg; paclitaxel 2367.8 mg; docetaxel 268 mg and oxaliplatin 73 mg. The difference in vials required to compound banded doses decreased for carboplatin, oxaliplatin, gemcitabine and fluorouracil, but increased for docetaxel and paclitaxel. Total differences in costs were an increase of $5580.93 based on milligrams but decrease of $24816.50 based on vials.

Conclusions: Potential cost implications of dose banding chemotherapy varied substantially depending on pricing according to milligram or vial, both of which were recommended by the EFC review. This preliminary analysis suggests services, especially pharmacy, may be financially impacted regardless of proposed changes introduced. Further studies are needed in more chemotherapy agents to fully understand the financial implications of chemotherapy dose banding in Australia.

212 | Identifying molecular key players in prostate cancer cell migration and metastasis

Calum J. Turpie¹, Paul J. Dunn¹, Catherine M. McDermott¹, Joan Roehl¹

¹Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia

Background: Prostate cancer remains the second most common cause of male cancer death in Australia, and this has been increasingly linked to metastatic disease status. Tumour cell migration is required throughout multiple steps of the metastatic cascade. Yet, which molecular key players drive tumour spread and metastatic potential in prostate cancer is not fully understood.

Methods: Prostate cancer cell lines LNCaP and PC-3, which differ in their androgen sensitivity and tumorigenicity, were used as minimally and highly metastatic cancer cell models. RNA was extracted from these models and cDNA generated through reverse transcription. PCR arrays (n = 3 per model) were performed to analyse differential gene expression of 84 cell motility genes (plus six reference genes) in the highly metastatic versus minimally metastatic prostate cancer model. Quality control checked for PCR array reproducibility, reverse transcription control, and genomic DNA contamination control.

Results: The top motility genes that were significantly more highly expressed in the highly metastatic cancer model (PC-3) compared to the minimally metastatic model (LNCaP) were CAV1, FGF2, ITGB2, MET, MMP14, PLD1, RAC2, RND3, TGFB1 and VIM (p values < 0.001). Interestingly, expression of MMP14, Matrix metalloproteinase-14, a transmembrane, zinc metalloprotease capable of degrading the extracellular matrix, was higher than the expression of other proteases from that family (MMP2 and MMP9), in both models, suggestive of the importance of MMP14 in the migration of prostate cancer cells. In contrast, expression of cell motility genes IGF1, PTEN and STAT3 were lost in the highly metastatic cancer model (PC-3) compared to the minimally metastatic model (LNCaP).

Conclusion: By advancing the understanding of differential expression of cell motility genes in prostate cancer, the project has the potential to contribute to our understanding of the mechanisms of prostate cancer progression, development of alternative therapeutic targets, and identification of novel prognostic markers.

213 | Exploring intimacy and sexual quality of life in prostate cancer: A qualitative study

Karina Rune¹, Chloe Pearson¹, Martin Moeller¹, Andrew Allen¹

¹The University of the sunshine Coast, Sippy Downs, QLD, Australia

Background: A prostate cancer diagnosis impacts both patients and their partners. While research has examined the biomedical aspects of sexual concerns, there is a scarcity of literature addressing long-term psychosocial factors affecting intimacy and sexual quality of life (SQoL) for prostate cancer survivors and their partners.

Aims: We explored experiences, thoughts, and behaviours contributing to intimacy and SQoL for prostate cancer patients and their partners, using the biopsychosocial model and interpersonal process model of intimacy as theoretical frameworks.

Methods: Using a qualitative research design, six prostate cancer survivors (Mage = 71.5 years; SD = 7.46 years) and two partners (Mage = 59.5; SD = 4.95) were recruited. Thematic analysis was used to identify key themes related to intimacy and SQoL.

Results: Preliminary themes centred around: (1) relationship dynamics, including quality of the relationship; (2) communication styles, such as open communication versus closed communication, and influence of growth versus fixed mindset; (3) healthcare experiences, such as lack of information and support; and (4) resilience factors, including persistence and goals of maintaining a satisfying SQoL.

Conclusion: This study underscores the influence of psychosocial factors on intimacy and SQoL of prostate cancer survivors and their partners. In alignment with the biopsychosocial model, our findings emphasise the need for comprehensive support and healthcare interventions that address the complex psychosocial dynamics impacting intimacy and SQoL following a prostate cancer diagnosis for both patients and partners. Future research should expand this investigation to patients and partners in diverse cancer populations to enhance our understanding of the impact psychosocial factors have on intimacy and SQoL.

214 | Clinical staff satisfaction and experience with implementation of a multidisciplinary model of community palliative care: A mixed methods study

Jessica Scaife^1,2,3, Sarah Moberley⁴, John Attia^5,6, Lisa MacKenzie^1,7, Rachel Hughes⁸, Peter Kozaczynski¹

¹Palliative Care, Calvary Mater Newcastle, Newcastle, NSW, Australia

²Medicine, University of Newcastle, Newcastle, NSW, Australia

³Calvary Healthcare, Warabrook, NSW, Australia

⁴Research Ethics, Hunter New England Health LHD, Newcastle, NSW, Australia

⁵Medicine, John Hunter Hospital, Newcastle, NSW, Australia

⁶Epidemiology, Hunter Medical Research Institute, Newcastle, NSW, Australia

⁷Psychology, University of Newcastle, Newcastle, NSW, Australia

⁸Palliative Care, St Vincents Hospital Lismore, Lismore, NSW, Australia

Aims: As part of a Randomised Control Trial (RCT) evaluating Specialist Palliative Community Service (SPCS) delivery models, an evaluation of staff professional quality of life and work experience was undertaken in the context of a clinically embedded research conducted during the COVID-19 pandemic.

Methods: A mixed-methods study was undertaken of multidisciplinary staff employed in a SPCS in New South Wales, Australia. This research was part of a single site RCT run between May 2021 and October 2022. All staff employed within SPCS were offered the chance to participate in three time-point surveys using Professional Quality of Life (PROQOL) questionnaire. Survey results were reviewed, analysed and overall descriptive statistics are reported for PROQOL subscales of compassion satisfaction, burnout, and traumatic stress. Staff also participated in focus groups exploring their experience, satisfaction and challenges. This abstract will focus on end of study results.

Results: End of Trial PROQOL was completed by 20 staff. Compassion Satisfaction mean score was 40.4 (SD 5.03) with all respondents in moderate (70%) or high (30%) categories. Burnout mean score was 31.75 (SD 3.30) with all respondents in moderate category. Secondary Trauma mean score was 19.8 (SD 4.7) with all in low (65%) or moderate (35%) category. Overall, four themes were identified in the focus groups: General acceptability of clinically embedded research; burden of responsibility of care; staff understanding of patient and carer experiences, and impacts of COVID pandemic on care delivery.

Conclusion: At study conclusion, while all participants reported moderate levels of burnout, there was reassuringly strong compassion satisfaction with professional roles. The themes identified provide further insight into impacts of embedded research during the volatility of the COVID-19 pandemic.

215 | A general practice toolkit to promote physical activity among people living with cancer

Renae A. Lawrence¹, Nicola W. Burton^2,3,4, Kerry Uebel¹, Sameera Ansari^5,6, Morgan Farley¹, Sonia Maroff⁷, Joel Rhee¹, Kylie Vuong^5,8

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

²School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia

³Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia

⁴Centre for Mental Health, Griffith University, Mt Gravatt, QLD, Australia

⁵School of Population Health, UNSW Sydney, Kensington, NSW, Australia

⁶Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia

⁷Consumer Investigator, Sydney

⁸School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia

Background: Physical activity is an important strategy to reduce the risk of cancer recurrence, cancer-specific and all-cause mortality, and disease- and treatment-related side effects. Physical activity also promotes physical and mental wellbeing. Despite established benefits, most patients don't receive physical activity recommendations or support, or meet the exercise oncology guidelines. Barriers to general practice staff promoting physical activity to cancer survivors include limited knowledge and access to resources. There is a need to build capacity in general practice to support cancer survivors to engage in and maintain physical activity.

Aims: This pilot project aims to develop, implement and evaluate the acceptability, feasibility, and utility of a general practice toolkit to assist general practitioners (GPs) and practice nurses (PNs) to promote physical activity among cancer survivors.

Methods: The toolkit comprises information and resources related to exercise benefits, recommendations, tips and options for GPs and PNs to promote physical activity to cancer survivors. We will recruit 15 GPs and PNs across general practices based in NSW and Queensland, a logistic maximum given available funding while still adequate to demonstrate intervention efficacy in a pilot study. Participants will be provided with the toolkit for a 3-month period. Evaluation will use a mixed-methods approach including pre- and post-intervention surveys and a semi-structured interview. Survey data on socio-demographics, frequency of use, acceptability, feasibility, and utility will be analysed using descriptive statistics and changes in practice, knowledge and attitudes will be analysed using t tests and ANOVA. Interviews will be transcribed verbatim prior to deductive thematic analysis.

Results: We plan to begin data collection from August 2024.

Conclusions: This research will provide information on a pragmatic condition and behaviour specific resource to build capacity among GPs and PNs and address an area of need within cancer survivorship. The research findings will inform future implementation trials.

216 | Exploring clinical trials awareness, information access and participation amongst Australians with ovarian cancer: A qualitative study

Natalie Williams^1,2, Hayley Russell², Bridget Bradhurst²

¹Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

²Ovarian Cancer Australia, Melbourne, VIC, Australia

Aims: Ovarian cancer is associated with late-stage diagnosis and poor survival rates. Clinical trials may improve quality of life, survival outcomes and treatment options when initial efforts have been exhausted. Challenges exist to clinical trials awareness and participation, and perspectives of Australians with ovarian cancer have not been previously investigated. This study aimed to investigate clinical trials awareness, information access and participation amongst Australians with ovarian cancer.

Methods: An exploratory qualitative approach was utilised in phase one of this two phase study. Women with ovarian cancer participated in online focus groups and interviews between December 2023 and February 2024. Data saturation was achieved after inclusion of 16 participants. Transcripts underwent inductive content analysis.

Conclusions: These qualitative insights informed the development of a cross-sectional survey for national distribution in phase two of the study. Results from both phases will be collectively used to address identified barriers by developing innovative solutions to improve access to information about clinical trials.

217 | Optimising gynaecological cancer nursing care: Nurse and consumer perceptions on the development of a guidance resource

Natalie Williams¹, Olivia Cook^2,3, Tracey Moroney¹, Sharon Maclean¹, Georgia Halkett¹

¹Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

²McGrath Foundation, Sydney, NSW, Australia

³Monash University, Melbourne, VIC, Australia

Publish consent withheld.

218 | Epithelial cell adhesion molecule induces induces Wnt receptor transcription to promote colorectal cancer progression

Han-Chung Wu^1,2, Sushree Shankar Panda¹, Chi-Chiu Lee¹, Chia-Ning Shen^2,3, Wen-Shan Li^2,4, Hsing-Pang Hsieh^4,5

¹Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan

²Biomedical Translation Research Center, Academia Sinica, Taiwan

³Genomics Research Center, Academia Sinica, Taipei, Taiwan

⁴Institute of Chemistry, Academia Sinica, Taiwan

⁵Institute of Biotech and Pharma Research, National Health Research Institutes, Miaoli County, Taiwan

Epithelial cell adhesion molecule (EpCAM) has been widely studied as a tumour antigen due to its expression in varieties of solid tumours. Moreover, the glycoprotein contributes to critical cancer-associated cellular functionalities via its extracellular (EpEX) and intracellular (EpICD) domains. In colorectal cancer (CRC), EpCAM has been implicated in the Wnt signaling pathway, as EpICD and β-Catenin are coordinately translocated to the nucleus. Once in the nucleus, EpICD transcriptionally regulates EpCAM target genes. Here, we studied the role of EpCAM in colorectal cancer (CRC) stemness. We found that the EpEX-induced Wnt signaling activates TACE and γ-secretase enzymes to augment shedding of EpEX and EpICD, establishing a positive feedback loop. Importantly, we show that the EpICD interacted with the promoters of Wnt receptors (FZD6 and LRP5/6) thus upregulated their transcriptional activity inducing Wnt signaling. Furthermore, activation of Wnt-pathway-associated kinases in the β-Catenin destruction complex (GSK3β and CK1) induced γ-secretase activity to augment EpICD shedding, establishing a positive-feedback loop. Our EpCAM-neutralizing antibody (EpAb2-6) and a porcupine inhibitor (LGK974) each partially attenuated cancer stemness, while their combination abolished stemness-related endpoints, induced apoptosis in vitro and markedly diminished tumour progression in animal models of human CRC. From these findings, we conclude that EpCAM stimulates Wnt signaling to promote cancer stemness, and the combination of EpAb2-6 and porcupine inhibitors may represent an effective CRC treatment, including for KRAS-mutant cancers. Thus, the mechanistic insights gained from our study may be useful to improve existing treatments or to develop novel anticancer therapeutics.

220 | The synergic effect of PD1 inhibitor and FLASH radiotherapy in a syngeneic mouse model of lung cancer: Preliminary results

Yujeong Yoon^1,2, Hong-rae Lee³, Tosol Yu^1,4

¹Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Gijang-gun, Busan, South Korea

²Convergence Medical Sciences, Pusan National University College of Medicine, Busan, South Korea

³Research Center, Dongnam Institute of Radiological and Medical Sciences, Gijang-gun, Busan, South Korea

⁴Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea

This study investigated the hypothesis that the dose rates of radiation can affects the tumour outcome of radiotherapy (RT) to synergize with anti-PD-1 antibody.

Lewis lung carcinoma cells were injected subcutaneously into syngeneic mice at two separate sites, defined as ‘primary’ site that was irradiated and a ‘secondary’ site outside the radiation field. When both tumours were in a range of 50–100 mm³, C57BL/6 male mice were randomly assigned to three groups receiving sham-RT (0 Gy), conventional dose-rate RT (CONV-RT), or ultra-high dose-rate RT (FLASH-RT). The dose rates of CONV-RT and FLASH-RT groups were 0.067 and 118 Gy/s, respectively. FLASH-RT was performed using the DIRAMS LINAC, producing 6-MeV electron beams. All of the groups were treated with anti-PD1 antibodies starting at the day of irradiation and the two irradiated groups were treated with 24Gy in one fraction.

During the 4-week observation period, the size of tumours at the secondary site did not differ among the three groups. The size of tumours at the primary site was significantly different between the RT and sham-RT groups, but not between the two RT groups.

In this experiment, we could not confirm the abscopal effect of RT in the LL2 tumour model, and there was no difference in irradiated tumour response between FLASH-RT and CONV-RT.

221 | Bundling and patient navigation in early-stage breast cancer care – Patient reported interim findings of a 100 patient pilot study

Yvonne Zissiadis¹, Sarah Wise², Wen Chan Yeow³, Helen Ballal³, Julia Schulz⁴, Nicola Forsyth¹

¹Radiation Oncology, GenesisCare, Perth, WA, Australia

²Centre of Health Economics Research and Evaluaton, University of Technology Sydney, Sydney, NSW, Australia

³St John Of God Hospital Subiaco, Perth, WA, Australia

⁴GenesisCare, Alexandria, NSW, Australia

Methods: The Pilot team partnered with CHERE at University Technology Sydney to complete an evaluation, utilising qualitative and quantitative data collection methods to inform both formative and summative findings from the pilot.

These early findings provide a snapshot of the patient experience of the Bundle. As data collection and analysis of costs and outcomes progresses, we will build a clearer picture of whether the Bundle is sustainable and provides value-based care. Final report due mid 2025.

Reference:

1. Zissiadis Y. et al. Designing and implementing a bundle of care for patients with early-stage breast cancer: lessons from a pilot program. Austr Health Rev. 2024;48(2):142-147.

222 | Opioid analgesics for people living with cancer

Christina Abdel Shaheed^1,2, Chris Hayes³, Christopher Maher^1,2, Jane Ballantyne⁴, Martin Underwood^5,6, Andrew McLachlan⁷, Jennifer Martin³, Sujita Narayan^1,2, Mark Sidhom^8,9

¹Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia

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

³College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, NSW, Australia

⁴University of Washington School of Medicine, Seattle, Washington, USA

⁵University Hospitals of Coventry and Warwickshire, Coventry, UK

⁶Warwick Clinical Trials Unit, University of Warwick, Coventry, UK

⁷Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Sydney, NSW, Australia

⁸Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia

⁹South Western Clinical School, University of New South Wales, Sydney, NSW, Australia

Aims: To evaluate the evidence on the benefits and harms of opioid medicines compared to placebo, other analgesics or non-pharmacological interventions for people with background and breakthrough cancer-related pain.

Methods: Electronic databases including the Cochrane Library, Medline EMBASE and PsycINFO were searched for systematic reviews, clinical trials, cohort studies or clinical guidelines up to February 2023 evaluating the benefits and/or harms of opioids for background or breakthrough cancer pain.

Results: There are few placebo-controlled trials evaluating opioids for cancer pain in adults. Currently, there is moderate-to-low certainty evidence that tapentadol or codeine may provide better pain relief than placebo for background cancer pain. Selected non-steroidal anti-inflammatory drugs including aspirin, piroxicam, diclofenac or ketorolac, and the antidepressant medicine imipramine are at least as efficacious as opioids for background cancer pain. Oral transmucosal, buccal, sublingual or intranasal fentanyl were all found to be more efficacious than placebo for breakthrough cancer pain, but were associated with more adverse effects including nausea and constipation. Although it is widely recommended as first line treatment in international guidelines, based on the current evidence morphine was generally not found to be superior to other opioids, nor was it considered to be safer. There was large heterogeneity in the studies, which makes interpretation and translation of study findings challenging. There is emerging in-vitro and preclinical evidence to suggest that certain opioids, including morphine, may affect the body's ability to fight cancer. However, the clinical implications needs to be explored rigorously in future studies.

Conclusion: There is limited evidence evaluating the efficacy of opioids compared with placebo for cancer pain in adults. This likely reflects the ethical and logistical challenges associated with carrying out these trials. Given the limited quantity and quality of data available, there is a need to reappraise the clinical utility of opioids for cancer pain.

224 | Trial in progress: An open label phase I multicenter clinical trial of S095035 (MAT2A inhibitor) in adult participants with advanced or metastatic solid tumours with homozygous deletion of MTAP

Charlotte Lemech¹, Andrae Vandross², Annette Ervin-Haynes³, Eric Baron³, Pauline Darcel⁴, Marine Gailledrat⁴, Ana Costa⁴, Amel Sadou-Dubourgnoux⁴, Malaka Ameratunga^5,6

¹Scientia Clinical Research, Randwick, NSW, Australia

²NEXT Oncology, Austin, TX, USA

³Servier Pharmaceuticals, Boston, MA, USA

⁴Institut de Recherche et Développement Servier, Paris-Saclay, France

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

⁶School of Translational Medicine, Monash University, Melbourne, Victoria, Australia

Background: Methylthioadenosine phosphorylase (MTAP) homozygous deletion is present in many human malignancies. The metabolic enzyme methionine adenosyltransferase 2α (MAT2A) is considered as a synthetic lethal target in MTAP deleted tumours. S095035 is an oral potent reversible inhibitor of MAT2A.

Preclinical pharmacology studies in MTAP-/- or null cell line-derived human tumour xenografts in mice demonstrated a dose-dependent reduction of SAM levels in plasma and tumour, correlating with tumour growth inhibition.

Methods: This Phase 1, open-label, multicentre clinical trial is investigating safety, tolerability and preliminary antitumour activity of S095035 administered as a single agent in patients with advanced or metastatic solid tumours with documented homozygous deletion of MTAP.

Approximately 27 eligible patients who have failed to respond to or have progressed after prior treatment, and for whom additional effective standard-of-care treatment is not available, will be enrolled in the dose finding study. S95035 will be administered orally once daily in a 28-day cycle dose escalation phase starting at 50 mg with a maximum dose of 600mg to be tested.

Time-to-event Bayesian optimal interval (TITE-BOIN) with adaptive dose modification (ADM) design will be used to guide the dose escalation process and the determination of the recommended dose for expansion (RD) and/or the maximum tolerated dose (MTD).

The primary objective of the Phase 1 study is to assess the safety and tolerability and identify the recommended dose (RD) and/or maximum tolerated dose (MTD).

Key secondary objectives include characterization of pharmacokinetics (PK), pharmacodynamics (PD) and preliminary antitumour activity using RECIST v1.1. Identification of predictive biomarkers and changes from baseline in intra-tumoral concentrations of SAM and MTA are key exploratory endpoints of the study.

Clinical trial information (NCT06188702).

225 | Time course of adverse events in primary advanced or recurrent endometrial cancer treated with dostarlimab plus chemotherapy in the ENGOT-EN-6-NSGO/GOG-3031/RUBY trial

Elizabeth Lokich¹, Trine L. Jørgensen², Destin Black³, David Cibula⁴, Lucy Gilbert⁵, Antonella Savarese⁶, Matthew A. Powell⁷, Rebecca Herbertson⁸, Sarah E. Gill⁹, Bradley J. Monk¹⁰, Nicole Nevadunsky¹¹, Kari L. Ring¹², Noelle Cloven¹³, Iwona Podzielinski¹⁴, Tashanna Myers¹⁵, Ashish Banerjee¹⁶, Christine Dabrowski¹⁷, Shadi Stevens¹⁸, Lyndsay Willmott¹⁹, Mansoor R. Mirza²⁰

¹Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA

²Department of Oncology, Odense University Hospital, Odense, Denmark

³Willis-Knighton Cancer Center, Willis-Knighton Health System, Gynecologic Oncology Associates, Shreveport, LA, USA

⁴Department of Gynaecology, Obstetrics, and Neonatology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic

⁵Division of Gynecologic Oncology, McGill University Health Centre and the Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada

⁶Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy

⁷National Cancer Institute sponsored NRG Oncology, Washington University School of Medicine, St Louis, MO, USA

⁸Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK

⁹St. Joseph's/Candler Gynecologic Oncology & Surgical Specialists, Candler Hospital, Savannah, GA, USA

¹⁰GOG Foundation, Florida Cancer Specialists and Research Institute, West Palm Beach, FL, USA

¹¹Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, NY, USA

¹²University of Virginia Health System, Charlottesville, VA, USA

¹³Texas Oncology, Fort Worth, TX, USA

¹⁴Department of Gynecologic Oncology, Parkview Health, Fort Wayne, IN, USA

¹⁵Baystate Medical Center, Division of Gynecologic Oncology, University of Massachusetts-Chan Baystate, Springfield, MA, USA

¹⁶GSK, Melbourne, Australia

¹⁷GSK, Collegeville, PA, USA

¹⁸GSK, London, UK

¹⁹Arizona Oncology, Phoenix, AZ, USA

²⁰Rigshospitalet, Copenhagen University Hospital, Copenhagen, and Nordic Society of Gynaecologic Oncology-Clinical Trial Unit, Copenhagen, Denmark

Aims: Safety has been reported for immunotherapy + chemotherapy combinations in endometrial cancer (EC), although the timing of adverse events (AEs) and the longer-term AE profile is not yet clear. This analysis examines the time course of study treatment-related AEs (TRAEs) during the phase 3 RUBY trial (NCT03981796; funding: GSK study 213361) of dostarlimab + carboplatin-paclitaxel (CP) versus placebo+CP in patients with primary advanced or recurrent EC (pA/rEC).

Methods: Patients with pA/rEC were randomized 1:1 to dostarlimab + CP or placebo + CP Q3W (six cycles), then dostarlimab or placebo monotherapy Q6W for up to 3 years. AEs were assessed per common terminology criteria for adverse events v4.03 and summarized by quarter.

Results: The safety population included 487 patients who received ≥1 dose of treatment (dostarlimab + CP: n = 241; placebo + CP: n = 246). TRAEs occurred in 97.9% and 98.8% of patients in the dostarlimab + CP and placebo + CP arms, respectively. The most common TRAEs in the dostarlimab + CP and placebo + CP groups were alopecia (52.3% and 48.4%), fatigue (47.7% and 48.0%), and nausea (45.6% and 40.7%). In both arms, the majority of the most common TRAEs (≥30%) and grade ≥3 TRAEs (≥10%) occurred within the first 3–6 months of treatment; TRAEs occurred after the first 12 months in 2.5% and 0.4% of the dostarlimab + CP and placebo + CP arms, respectively. The timing of immune-related AEs was generally consistent with this finding.

Conclusions: Most TRAEs seen in the RUBY trial occurred within the first 3–6 months, with limited differences between arms. This timing is consistent with the patients’ receipt of chemotherapy. Few patients experienced onset of new TRAEs in the dostarlimab + CP arm after 12 months. These data further support a favourable long-term benefit-risk profile of dostarlimab + CP in patients with pA/rEC.

©2024 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2024 ASCO Annual Meeting. All rights reserved.

226 | Post-progression survival outcomes in patients with primary advanced or recurrent endometrial cancer (pA/rEC) in the ENGOT-EN6-NSGO/GOG-3031/RUBY trial who received follow-up immunotherapy

Mansoor R. Mirza¹, Cara Mathews², Lucy Gilbert³, Line Bjørge⁴, Kari L. Ring⁵, Mikalai Pishchyk⁶, Kathryn Pennington⁷, Yakir Segev⁸, Matthew A. Powell⁹, Toon Van Gorp¹⁰, David Bender¹¹, Kellie Schneider¹², Rachel Miller¹³, Amy Armstrong¹⁴, Guilherme Cantuaria¹⁵, Radhika Gogoi¹⁶, Ashish Banerjee¹⁷, Grace Antony¹⁸, Shadi Stevens¹⁸, Giorgio Valabrega¹⁹, Lisa M. Landrum²⁰

¹Rigshospitalet, Copenhagen University Hospital, Copenhagen, and Nordic Society of Gynaecologic Oncology-Clinical Trial Unit, Copenhagen, Denmark

²Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA

³Division of Gynecologic Oncology, McGill University Health Centre and the Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada

⁴Haukeland University Hospital, Bergen, and University of Bergen, Bergen, Norway

⁵University of Virginia Health System, Charlottesville, VA, USA

⁶Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy

⁷Fred Hutchinson Cancer Center, University of Washington Medical Center, Seattle, WA, USA

⁸Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel

⁹National Cancer Institute-sponsored NRG Oncology; Washington University School of Medicine, St. Louis, Missouri, USA

¹⁰University Hospital Leuven, Leuven Cancer Institute, KU Leuven, Belgium and the Belgian and Luxembourg Gynaecological Oncology Group (BGOG), Belgium and Luxembourg

¹¹Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA

¹²Department of Gynecologic Oncology, Novant Health Cancer Institute, Charlotte, NC, USA

¹³Department of Obstetrics and Gynecology, Markey Cancer Center, Lexington, KY, USA

¹⁴Division of Gynecologic Oncology, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Cleveland, OH, USA

¹⁵Northside Hospital, University Gynecologic Oncology, Atlanta, GA, USA

¹⁶Department of Gynecologic Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

¹⁷GSK, Melbourne, Australia

¹⁸GSK, London, UK

¹⁹Department of Oncology, Ordine Mauriziano Torino and University of Torino, Torino, Italy

²⁰Indiana University Health & Simon Cancer Center, Indianapolis, IN, USA

Aims: In Part 1 of the phase 3 ENGOT-EN6-NSGO/GOG-3031/RUBY trial (NCT03981796; funding: GSK), dostarlimab+carboplatin-paclitaxel (CP) significantly improved PFS (HR 0.64) and OS (HR 0.69) versus placebo+CP in the overall population of patients with pA/rEC. Limited data are available on outcomes with follow-up anticancer treatment (FUACT) after dostarlimab+CP. Here we report post-progression survival outcomes of patients in the overall and mismatch repair proficient/microsatellite stable (MMRp/MSS) populations who received FUACT of immunotherapy (IO).

Methods: Patients were randomized 1:1 to receive dostarlimab/placebo+CP Q3W (six cycles) followed by dostarlimab/placebo monotherapy Q6W for ≤3 years. At interim analysis 2 (37.2 mo of follow-up), updated post hoc analyses of OS adjusted for treatment switching via rank-preserving structural failure time (RPSFT) were performed in the overall and MMRp/MSS populations of pts who received FUACT of IO and for patients receiving pembrolizumab-lenvatinib (PEM-LEN) in the MMRp/MSS population.

Results: In total, 494 patients were randomized. FUACT of IO was received by 137 and 102 patients in the overall and MMRp/MSS populations, respectively; PEM-LEN was received by 65 patients in the MMRp/MSS population.

Approximately twice as many patients received FUACT of IO in the placebo+CP versus dostarlimab+CP arm. When adjusted for subsequent IO, RPSFT analyses showed HRs of 0.63 (overall) and 0.76 (MMRp/MSS) for dostarlimab+CP versus placebo+CP, consistent with the unadjusted HRs for OS in the primary analysis. In the MMRp/MSS population receiving subsequent PEM-LEN, HR of RPSFT-adjusted OS was also consistent at 0.77.

Conclusions: Adjusted OS using RPSFT for subsequent use of IO in the overall and MMRp/MSS populations, including PEM-LEN in the MMRp/MSS population, showed limited impact on survival benefits, supporting frontline use of dostarlimab+CP as standard of care in all patients with pA/rEC.

Previously presented at the European Society of Medical Oncology Congress 2024, poster/oral: 731P, Mirza MR, et al. – reused with permission.

227 | Influence of p16 (HPV) status on head and neck squamous cell carcinoma behaviour: A retrospective study

Emily Frances Brown¹, Alexis Andrew Miller¹, Udit Nindra¹, Daniel Brungs¹

¹Illawarra and Shoalhaven Cancer Care Centres, West Wollongong, NSW, Australia

Background: Head and neck squamous cell carcinoma (HNSCC) represent a complex group of malignancies originating from the mucosal linings of the upper aerodigestive tract. Despite therapeutic advancements, HNSCC is associated with high recurrence rates, morbidity, and mortality. The p16 (HPV) status has emerged as a potential prognostic marker, with HPV-positive tumours exhibiting distinct clinical characteristics and outcomes compared to HPV-negative counterparts. This study aims to investigate the impact of p16 status on HNSCC behaviour in patients with oropharyngeal SCC.

Methods: This retrospective cohort study included patients with primary stages I–III oropharyngeal SCC treated at the Illawarra and Shoalhaven Cancer Care Centres from 2013 to April 2024. Data was collected from electronic medical records, including demographic information, smoking status, clinical characteristics (tumour site, stage), treatment modalities, p16 status, and recurrence status (location, time to recurrence). Inclusion criteria encompassed patients with stages I–III oropharyngeal SCC treated with curative intent and known p16 status.

Results: Two-hundred and thirty-seven patients with oropharyngeal cancer were identified. Median duration of follow up was 45 months. Most patients were p16 positive (n = 199, 84.0%). Most patients (84.0%) were treated with primary radiotherapy or chemoradiotherapy, with 16.0% undergoing primary surgery with or without adjuvant chemo/radiotherapy. Forty-one patients (17.3%) had recurrent disease. p16 status was not associated with disease free survival (log rank p = 0.81), risk of locoregional recurrence (p = 0.84) or risk of distant failure (p = 0.68). p16 negative patients recurred sooner, with all recurrences occurring within 2 years, while p16 positive patients developed recurrent disease beyond 5 years of follow up.

Conclusion: p16 status was not associated with risk of relapse or site of recurrent disease, but those with p16 positive disease demonstrated a more prolonged duration of risk of recurrence, this suggests follow up protocols may be tailored by p16 status.

228 | Nutritional needs in patients with recurrent/metastatic Head & Neck Cancer (R/M HNSCC) receiving immune checkpoint inhibitors (ICI)

Teresa Brown^1,2, Belinda Camilleri¹, Judy Bauer³, Michelle Nottage¹, Brett G.M. Hughes^1,4

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

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

³Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia

⁴School of Medicine, University of Queensland, Brisbane, QLD, Australia

Aims: Although ICI have significantly improved outcomes for patients with R/M HNSCC,^1,2 the impact on patients’ nutritional status and the role of the dietitian and nutrition intervention in the era of ICI remains unclear. The aim of this study was to increase understanding of nutrition outcomes of patients undergoing immunotherapy.

Methods: Patients with a diagnosis R/M HNSCC treated with ICI between 2015–2023 at RBWH were included in this retrospective cohort study. Data collection occurred for the first three cycles of treatment and included weight change, nutritional status, presence of nutrition impact symptoms and dietary referrals and nutrition interventions.

Results: 89 patients (74 males (83%); mean age 64.5 ± 10) received ICI. Most common primary tumour diagnosis was oral cavity (n = 40, 45%) or oropharynx (n = 37, 42%).

Patients were treated with Nivolumab (n = 46, 52%), Pembrolizumab (n = 30, 34%) or Pembrolizumab-Carboplatin-5FU (n = 13, 14%), with 83 patients (93%) completing two cycles, and 64 (72%) completing three cycles. Ten patients were malnourished at commencement of treatment, and 21 had a feeding tube in-situ (67% G tube; 33% NGT). Nearly half were already under the care of a dietitian (n = 41, 46%).

Ten additional patients were referred at Cycle 1 (C1), with the most common nutrition impact symptoms; fatigue (n = 40, 45%), constipation (n = 22, 25%), nausea (n = 14, 16%), and anorexia (n = 13, 15%). Symptoms remained similar at C2 and C3, although fatigue increased (68% and 61%, respectively), and nausea increased by C3 (22%). Median weight change from baseline to C3 was −1.2% but varied considerably from −15% to +10%. Referrals to the dietitian continued throughout treatment (C2 n = 12; C3 n = 5).

Conclusions: Dietetic support remains important during palliative ICI due to presence of malnutrition, ongoing nutrition impact symptoms and requirement for tube feeding. Further co-design of optimal models of care are recommended to ensure appropriate patient support during this time.

References:

1. Burtness B, Harrington KJ, Greil R, Soulières D, Tahara M, de Castro Jr. G., et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019;394(10212):915-1928. doi: https://doi.org/10.1016/S0140-6736(19)32591-7

2. Ferris RL, Blumenschein Jr G, Fayette J, Guigay J, Colevas D, Licitra L, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med. 2016;375(19):1856-1867. doi: 10.1056/NEJMoa1602252

229 | Investigating the impact of skull base surgery on nutrition and swallowing outcomes

Joanne Hiatt¹, Teresa Brown^1,2, Ryan Sommerville¹, Abigail Walker¹, Clare Burns¹, Laura Moroney¹, Brett G.M. Hughes^1,3, Judy Bauer⁴

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

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

³School of Medicine, University of Queensland, Brisbane, QLD, Australia

⁴Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia

Aims: The primary aim was to investigate nutrition and swallowing outcomes in patients undergoing complicated skull base surgery for malignant and non-malignant lesions. The secondary aim was to compare outcomes between those who receive pre-surgical dietitian and speech pathology screening through an established multidisciplinary team meeting (Group A), and those who do not receive this screening (Group B).

Methods: Five-year retrospective cohort study of patients who underwent complicated skull base surgery at RBWH (2018–2022). Nutrition and swallowing outcomes were evaluated at baseline, during admission and up to 3-months post-operatively, including malnutrition risk, nutritional status, weight change, diet prescription and a diagnosis of dysphagia by the speech pathologist.

Results: Forty patients were included (n = 11 Group A; n = 29 Group B), mean age 57 ± 14.9 years and 70% male. Overall, 21% of patients were screened as being at risk of malnutrition. Both groups experienced similar weight loss (approximately 10% at 3-months post-surgery) and dysphagia was equally common in both groups (24% during inpatient admission and 13% at 3-months post-surgery).

Group A patients, versus Group B patients, had higher rates of malnutrition at baseline (14% vs. 0%) and at 3-months post-surgery (50% vs. 40%). More Group A patients, versus Group B patients, were on a texture modified diet at baseline (27% versus 0%) and at 3-months post-surgery (63% vs. 50%). Overall, 18% of patients required post-operative tube feeding, with one patient from Group B still reliant on enteral feeding at 3 months post-surgery. A study limitation was the small sample size in Group A and a higher prevalence of missing data in Group B.

Conclusions: All patients undergoing complicated skull base surgery are at risk of developing malnutrition and dysphagia. This research highlights the need for multidisciplinary allied health support and the development of evidence-based guidelines to ensure patients receive necessary care.

230 | A pelvic floor rehabilitation program for patients with low anterior resection syndrome after sphincter-preserving surgery for colorectal cancer: A feasibility study

Kin Yin Carol Chan^1,2, Michael Suen^1,2, Gemma Collett¹, Susan Coulson¹, Janindra Warusavitarne³, Janette Vardy^1,2

¹The University of Sydney, Sydney, NSW, Australia

²Concord Repatriation General Hospital, Concord, NSW, Australia

³St. Mark's Hospital, London, UK

Aim: Low anterior resection syndrome (LARS) is common after colorectal cancer (CRC) surgery. We examined the feasibility and efficacy of a pelvic floor rehabilitation (PFR) program for CRC survivors with LARS surgery and treatment.

Method: Prospective, single-arm PFR pilot study. Eligibility criteria: sphincter-preserving anterior resection for CRC (±neoadjuvant/adjuvant treatment, ±reversed temporary stoma); sustained bowel symptoms with LARS score >20, minimum 6 months after surgery. The intervention was a 10-week supervised PFR program including: education, biofeedback, pelvic floor muscle training, home exercises. The program was conducted in outpatient clinic with/without telehealth (COVID-19 adaptations). Primary outcome: PFR program adherence and compliance. Secondary outcomes: bowel, bladder, sexual dysfunction; quality-of-life (QOL); anorectal physiology parameters. Descriptive data analysis and Chi-squared test were undertaken.

Results: A total of 15 participants (Mean age 61, 44–81 years; male = 8), eight participants received hybrid physical/telehealth treatment. Cancer type: rectal 13; sigmoid 2. Surgery: high (1), low (3) and ultralow (11) anterior resection. Previous temporary stoma: 11/15, mean duration 4.8 months (range 2–10). Five had neoadjuvant chemo/radiotherapy, seven adjuvant chemotherapy. Time since bowel continuity restored: mean 19.5 (range 7–60) months. One participant withdrew after week 2; 14/15 included in final analysis. Intervention adherence was high: 100% attendance; 96% self-reported home exercise program completion. High satisfaction level rating: excellent (60%), very good (27%). After PFR, faecal incontinence and frequency reduced (p < 0.05). LARS (95%CI 6.1,18 p < 0.001), MSKCC-BFI bowel function (95%CI −14.4, −4.2 p = 0.01), female bladder function (95%CI 1.1, 8.6 p = 0.019) scores improved. Faecal incontinence QOL score improved: +0.6 (95%CI −0.9, −0.2 p < 0.001). Anorectal physiology parameters: mean squeeze pressure, push relaxation and rectal sensory volume thresholds all increased: 9.5%, 70%, 37%, respectively (p < 0.05).

Conclusion: A PFR program is feasible and highly adhered to by CRC survivors with LARS. PFR improved bowel symptoms, QOL, and anorectal physiological function.

231 | An audit of medical oncology patients who died within 30 days of systemic anticancer therapy

Millicent Chapman¹, Ortis Estacio¹, Oliver Nilsen¹, Umbreen Hafeez^1,2,3,4, Belinda Yeo^1,4

¹Austin Health, Melbourne, Victoria, Australia

²Melbourne University, Melbourne, Victoria, Australia

³Latrobe University, Melbourne, Victoria, Australia

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

Aims: The quantity and type of systemic anticancer therapy (SACT) has increased over recent years, leading to augmented patient survival and quality of life. However, SACT near end of life can contribute to significant patient morbidity and mortality. According to previous studies, the percent of patients receiving SACT within 30 days of death compared to all oncology deaths is reportedly between 8% and 32%.¹ This study was undertaken to evaluate the patient characteristics and types of SACT used in oncology patients who die within 30 days of receiving SACT and identify factors associated with its use in patients close to the end of life.

Methods: A retrospective audit review of medical records was conducted on medical oncology patients treated at tertiary hospital who died within 30 days of receiving intravenous SACT, between 1 January 2019 to 31 December 2023. Patient information will be collected related to demographics, cancer type, treatment type and intent, mortality data. Logistic regression analyses will be used to identify potential risk factors associated with death potentially from treatment complications.

Results: Two thousand four hundred and nineteen patients with cancer were identified to have died as an inpatient within the 5 years. Of these 281(11.6%) have been screened as having intravenous SACT within 30 days of death. Further analyses on the 281 patients to follow.

Conclusions: Conclusions to follow prior to COSA ASM in November 2024 once all analysis is completed.

Reference:

1. Geyer T, Le N, Groissenberger I, Jutz F, Tschurlovich L, Kreye G. Systemic anticancer treatment near the end of life: a narrative literature review. Curr Treat Options in Oncol. 2023;24(10):1328-1350.

232 | Socioeconomic status and its impact on stage at diagnosis and survival in women with breast cancer in Korea: A K-CURE study

Sun Hyung Choi¹, Danbi Lee², Bombi Park¹, Eun-Gyeong Lee¹, Jai Hong Han¹, Seeyoun Lee¹, So-Youn Jung¹, Young Ae Kim²

¹Department of Surgery, Center for Breast Cancer, National Cancer Center, Ilsan, Goyang, South Korea

²Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Ilsan, Goyang, Korea

Purpose: This study aims to evaluate the variation in breast cancer stage at diagnosis and survival rates based on socioeconomic status (SES) using a population-based retrospective cohort.

Methods: We used data from the Korean Clinical Data Utilization for Research Excellence project (K-CURE) to analyse the SEER stage, SES by medical insurance status and mortality for 127,475 female breast cancer patients diagnosed between 2014 and 2019.

Results: SES was categorized into five groups based on statistical percentiles: medical benefit group (lowest SES, n = 4127, 3.2%), 1st quartile (n = 31,274, 24.5%), 2nd quartile (n = 30,287, 23.8%), 3rd quartile (n = 25,641, 20.1%), and 4th quartile group (highest SES, n = 36,146, 28.4%).

In terms of stage distribution by SES, the 4th quartile group had the highest percentage of local stage cases (62.6%) compared to the medical benefit group (51.8%), 1st quartile (57.4%), 2nd quartile (57.4%) and 3rd quartile (58.8%). Conversely, advanced stage cases were more prevalent in the medical benefit group (7.9%) compared to the 1st quartile (5.3%), 2nd quartile (5.3%), 3rd quartile (4.5%) and 4th quartile (3.8%).

Regarding overall survival rates, the medical benefit group had a poorer prognosis across all stages: local stage (90.5% in the medical benefit group vs. 97.9% in the 1st quartile, 97.8% in the 2nd quartile, 97.9% in the 3rd quartile, and 97.7% in the 4th quartile, p-value < 0.0001), regional stage (83.9%, 92.8%, 93.7%, 93.6% and 93.6%, p-value < 0.0001), and distant stage (37.7%, 48.8%, 54.9%, 54.8% and 56.4%, p-value < 0.0001). These results were consistent in the breast cancer-specific survival rate analysis.

Conclusions: Despite South Korea's health insurance system covering most treatment costs our study indicates that economically disadvantaged patients are diagnosed at more advanced stages and have poorer overall survival rates. These findings suggest the need for enhanced and targeted social support for economically disadvantaged breast cancer patients.

233 | An individualised bone-targeted exercise intervention for people with multiple myeloma: Study protocol of the MyeEx-impact randomised controlled trial

Jamie Chong¹, Jennifer Nicol^1,2, Belinda Beck³, Shelley Kay⁴, Nicolas Hart², Daniel Carter¹, Carmel Woodrow⁵, Brent Cunningham^1,6, Morgan Farley¹, Alexander Boytar¹, Brenton Baguley⁷, Grace Rose⁶, Peter Mollee^5,8, Tina Skinner^1,2

¹School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia

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

³Griffith University, Gold Coast, QLD, Australia

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

⁵Division of Cancer, Princess Alexandra Hospital, Brisbane, QLD, Australia

⁶School of Health − Sports & Exercise Science, University of the Sunshine Coast, Sunshine Coast, QLD, Australia

⁷Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia

⁸Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

Focal bone lesions are one of the strongest independent predictors of poor prognosis for people with multiple myeloma (MM). Preclinical evidence has shown mechanical load-induced changes in bone cell activity through bone-targeted exercises can delay osteolytic bone metastases. Whether bone-targeted exercises can improve bone health in people with MM, where bone pain, lesions, and fractures are common, requires investigation. This trial aims to determine the effect of bone-targeted exercises on the bone health of people with MM.

People with MM (n = 78) will be randomised to an exercise (EX) or control (CON) group. The EX group will perform two supervised and one unsupervised session of individualised, bone-targeted exercise training weekly for 9 months. The CON group will continue receiving standard care and maintain their current physical activity levels. Primary (bone density and microarchitecture) and secondary (bone pain, quality of life, fatigue, physical function, psychological constructs, gut microbiome, disease response, and biomarkers of bone health, immune function, and disease progression) outcomes will be assessed at baseline, 3- and 9-months. Adverse events, attendance, and adherence will be monitored and cost-effectiveness analysis performed. Linear mixed models will examine group by time differences for all variables of interest. Data will be analysed on an intention-to-treat basis. Semi-structured interviews will be conducted and coded to determine the experiences of participants and the perceived benefits and barriers of the intervention.

The findings of this study will identify whether bone-targeted exercise is safe, feasible, and can improve bone health in people with MM. Furthermore, this study will provide evidence of the effects of bone-targeted exercise on common MM- and treatment-related side-effects, as well as the potential mechanisms underpinning these effects. Collectively, this novel study will identify the potential role of exercise as an adjuvant therapy for the management of bone and psychosocial health for people with MM.

234 | What is the ideal dosing regimen for standardised ginger as an adjuvant CINV intervention in adults and children

Megan Crichton¹, Molly Warner², Lynette Law³, Uyen Nhu Tran⁴, Xueying Tang⁵, Skye Marshall^1,6

¹Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia

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

³Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC, Australia

⁴Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia

⁵Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, QLD, Australia

⁶Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia

Aims: There is substantial interest in ginger as an adjuvant therapy for chemotherapy-induced nausea and vomiting (CINV). However, an up-to-date evidence synthesis to guide optimal dosing regimen is lacking, which hinders translation into practice. This study aimed to synthesise the evidence on the effect of ginger on CINV compared to placebo or usual care.

Methods: This systematic review and meta-analysis evaluated the safety, effect, and optimal dosing regimen of oral ginger supplementation on CINV in people of any age. Five databases were searched from inception to September 2023 for controlled trials. Quality of evidence was appraised with Cochrane RoB2 and GRADE. Data were pooled using Revman.

Results: n = 29 studies were included (8% of participants were children; 83% of studies administered ginger in capsule form). In adults, ginger supplementation of any dose, duration, and frequency reduced the likelihood of acute nausea incidence by 40% (OR: 0.6; 95%CI: 0.41, 0.80; GRADE: Moderate) and delayed nausea incidence by 30% (OR: 0.7; 95%CI: 0.52, 0.97; GRADE: Moderate). Examination of dosing regimens found that administration of ginger 3-4 times daily and intervention duration >3 days were beneficial for nausea incidence. In adults, ginger of any dosing regimen reduced likelihood of acute vomiting by 60% (95%CI: 0.25, 0.71; GRADE: Low) and number of acute (SMD: −0.6; 95%CI: −0.89, −0.22; GRADE: Moderate) and delayed vomiting episodes (SMD: −1.0; 95%CI: −1.55, −0.36; GRADE: very low). Ginger had no effect on anticipatory nausea incidence, acute nor delayed nausea severity, nor any adverse event. Data were unable to be pooled for studies on children.

Conclusions: Administration of ginger 3–4 times daily and for >3 days might be favourable for CINV in adults, but optimal ginger dose remains inconclusive, and evidence is scarce in children.

235 | Understanding the individualisation of exercise prescription for people with cancer: A systematic review

Brent Cunningham^1,2, Jamie Chong³, Ciaran M. Fairman⁴, Grace L. Rose^1,3, Tina L. Skinner^3,5

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

²The Office of the Pro Vice Chancellor (Health), Griffith University, Gold Coast, QLD, Australia

³School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia

⁴Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

⁵School of Health Sciences, University of New South Wales, Sydney, NSW, Australia

Purpose: The importance of prescribing individualized exercise for people with cancer to minimize injury risk and optimize outcomes has been echoed internationally in position and consensus statements. However, it is unclear what individualization processes are employed in exercise oncology research and how exercise individualisation is implemented for people with cancer. This study aimed to systematically review the available evidence to elucidate the individualisation methods being employed in exercise oncology research.

Methods: A systematic search of PubMed, EMBASE, CINAHL, and Web of Science was performed following the PRISMA guidelines. Eligible randomised controlled trials (RCT), controlled trials (CT), pre-post trials, and comparison trials included men and women aged ≥18 years with a histologically confirmed diagnosis of cancer; undertaking any structured exercise protocol that was ‘individualized’, with or without supervision; and that explored outcomes of intervention fidelity (e.g., recruitment, attendance, adherence, attrition), and/or patient health and wellbeing (i.e., quality of life, symptom improvement, medication use, physical activity). Study quality was assessed using the Delphi list tool.

Results: Sixty-three studies were found to be eligible and subsequently included in the narrative synthesis. Study quality was on average 49% (range 14%–100%). Individualization of the exercise prescription most occurred before intervention commencement (n = 23, 47%), based on physiological results from baseline assessments (n = 21, 43%). No study individualized exercise based on participant readiness to train. The exercise prescription was predominantly individualized via modulation of both the intensity and volume of exercise (11, 22%).

Conclusion: Exercise prescription individualization for people with cancer is highly prescriptive and predetermined. Seldom has exercise prescription been individualized based on participant readiness to train nor meet guideline definitions. Future exercise oncology studies should include greater detail on the reporting of exercise individualization methods and rationale to enhance our understanding of the relationship between individualization and outcomes in people with cancer.

236 | Diet quality is not associated with malnutrition, low muscle mass and sarcopenia during lung cancer treatment

Annie R. Curtis¹, Nicole Kiss^1,2, Robin M. Daly¹, Anna Ugalde³, Katherine M. Livingstone¹

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

²Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

³Institute for Health Transformation, Deakin University, Geelong, VIC, Australia

Aims: Studies evaluating the impact of diet quality on nutrition and muscle-related outcomes in cancer are limited. We aimed to understand the diet quality of adults with lung cancer and the relationship between diet quality and malnutrition, low muscle mass (LMM) and sarcopenia.

Methods: Dietary data, using 3-day food records, were collected from 47 adults with lung cancer prior to- or within one-week of radical intent (chemo)radiotherapy (mean ± SD 70.6 ± 8.6 years; 58% male; 91.5% NSCLC). Diet quality was estimated using Dietary Guidelines Index (DGI; scored 0–115) and Mediterranean Diet Score (MDS; scored 0–9), reflecting established healthy eating patterns. Malnutrition was determined using patient generated subjective global assessment. LMM was estimated using diagnostic third lumbar vertebra CT images (M: <43 cm²/m² if BMI <24.9 kg/m² or <53 cm²/m² if BMI >25 kg/m²; F: <41 cm²/m²). Sarcopenia was determined using the revised European Working Group for Sarcopenia in Older People definition. Multivariate adjusted logistic regression analyses, odds ratios (OR) and 95% confidence intervals (CI), determined associations between diet quality and malnutrition, LMM and sarcopenia.

Results: Prevalence of malnutrition, LMM and sarcopenia were 36.2%, 50.0% and 13.6%, respectively. Mean ± SD DGI adherence score was 53.0 ± 13.0. Adherence to the DGI was not significantly associated with malnutrition (OR, 0.67 [95%CI 0.35, 1.28]), LMM (0.90 [95%CI 0.47, 1.70]) or sarcopenia (0.73 [95%CI 0.29, 1.80]). MDS adherence score was 3.6 ± 1.5. Adherence to the MDS was not significantly associated with malnutrition (0.75 [95%CI 0.37, 1.49]), LMM (0.98 [95%CI 0.51, 1.88]) or sarcopenia (1.82 [95%CI 0.72, 4.85]).

Conclusions: People with lung cancer had low diet quality, as estimated by DGI and MDS, but neither diet quality score was associated with odds of malnutrition, LMM or sarcopenia. Further research is needed to determine whether modifications (e.g., increased protein content) to high quality dietary patterns may support nutritional status as well as long-term cancer and health outcomes.

237 | Colorectal cancer survivorship in a cohort of Sri Lankan patients; the time to widen focus from the care of acute patients to long-term survivors

Raeed Deen¹, Pramodh Chandrasinghe²

¹Gold Coast University Hospital, Gold Coast, QLD, Australia

²University of Kelaniya, Colombo, Sri Lanka

Publish consent withheld.

238 | Exploring the long-term experiences, needs and coping strategies of people living with haematological cancer

Haryana Dhillon¹, Shaun Kirsten¹, Stephanie Tsany¹, Joanne Shaw¹, Rebekah Laidsaar-Powell¹

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

Background: Haematological cancers encompass a wide and complex cluster of diseases including leukaemia, lymphoma, and myeloma. Each has chronic and acute forms, rendering prognosis varied. Those diagnosed consistently demonstrate poorer psychosocial and survivorship outcomes. However, little is known about the persistent unmet needs of haematological cancer survivors (HCS).

Aim: We aimed to explore the experiences of HCS, specifically leukaemia or myeloma, and to develop a theoretical model of haematological cancer survivorship.

Methods: Inductive qualitative methodology was applied through thematic and framework analysis to two cohorts of haematological cancer survivors (HCS) in Australia. HCS aged >18 years, diagnosed with myeloma or leukaemia as an adult in the past 10 years or >6 months post-initial and active treatment completion or if receiving maintenance therapy >12 months post-diagnosis. Semi-structured telephone interviews were conducted with HCS recruited via social media and cancer advocacy organisations. Transcribed interviews were thematically analysed using framework methods after thematic saturation was achieved in each cohort independently.

Results: We interviewed 52 HCS (leukaemia n = 24; myeloma n = 28). Across both cohorts we identified four themes: (1) Impact − haematological cancer is complex, chronic and debilitating; (2) Uncertain and never-ending burden; (3) Work is central, coveted, and a struggle; (4) dynamic landscape of coping. Across both cohorts there was a clear meta-theme indicating HCS is recursive and holistic.

Participants described enduring challenges caused or exacerbated by HCS, for example complex and fluctuating emotions. Although problem-focused, emotion-focused, and meaning-based coping strategies were used, some felt resigned to their disease identity in the long-term, disrupting coping.

Conclusions: Our results provide novel insights to the existing limited evidence-base, particularly the extensive psychosocial impacts and challenges faced in long term survivorship. HCS would benefit from a holistic, continuum-based approach to developing models of HCS and survivorship services.

239 | Establishing an internal audit program for investigator initiated & collaborative group trials

Joel Ernest¹, Sally Mongta¹

¹Peter MacCallum Cancer Centre, Parkville, VIC, Australia

Background: Auditing is essential for clinical trial quality assurance, patient care and compliance with regulatory requirements. The Parkville Cancer Clinical Trials Unit (PCCTU) has introduced a risk-based Internal Audit Program (IAP) for IIT and Collaborative Group Trials, contributing to a developing Quality Management System.

Methods: Working within their usual workload, 12 PCCTU staff volunteered to become auditors forming an Internal Audit Group (IAG). All staff received appropriate training. Trials were selected randomly, and the audits were conducted on a single day every quarter in groups of three. Study teams were not notified in advance of an audit. An audit tool was developed to guide and record observations with key areas for review including delegation and training, consent and eligibility, the investigator site file, disease response and SAE reporting. Source data verification was not included in the audits.

Findings were summarised by the auditors and submitted to the Quality Manager for review. Study specific findings requiring action were communicated to the study team directly.

Results: Eight internal audits were completed over 12 months and highlighted repeated deficiencies in documentation across multiple areas. These included: eligibility, disease response and adverse event causality. Visibility of principal investigator oversight was also noted to be inconsistent. In contrast, informed consent documentation and essential document management was excellent. Identified themes were investigated and preventive actions communicated in targeted education sessions to all members of the study team.

Conclusions: The introduction of an IAP identified deficiencies in documentation. In response, this program has promoted a state of audit readiness, provided positive feedback to study teams and improved the consistency of quality management. Of note, the IAG reviewed academic studies not routinely monitored and has established metrics to support and drive an evolving quality management system. This program is adaptable to all clinical trial units without additional cost.

240 | Protocol investigator teams – Where are the nurses? A retrospective audit of collaborative clinical trial protocols

Belinda S. Fazekas¹, Angela Rao-Newton², Anna Dowd³, Annmarie Hosie⁴, Linda Brown⁵, Jane Phillips⁶, Julie Wilcock⁷, Robin O'Reilly⁷, Indy Khera⁸, Kathryn Robinson⁹

¹University of Technology Sydney, Ultimo, NSW, Australia

²School of Nursing, University of Tasmania, Launceston, Tasmania, Australia

³Palliative Care, Barwon Health, Geelong, VIC, Australia

⁴Nursing, The University of Notre Dame, Darlinghurst, NSW, Australia

⁵Translational Research, Clinical Trials, Strategic Projects & Response, Safer Care Victoria, Melbourne, VIC, Australia

⁶School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia

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

⁸Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia

⁹Medical Oncology, Austin Health, Heidelberg, VIC, Australia

Introduction: Study coordinators/nurses play a critical role in operationalising trial protocols but are rarely involved in protocol development, even in collaborative trial groups. The Palliative Care Clinical Studies Collaborative (PaCCSC) and Cancer Symptom Trials (CST) protocols are developed, as per GCP guidelines, ensuring that clinical, statistical, management, consumer, and specialist expertise are included in investigator teams from trial conception. Once developed, and ethically approved, protocols are presented to sites for implementation. At this stage, study coordinators/nurses have an opportunity to review the protocol and plan screening, recruitment, and trial management. At this point, important issues are often identified, resulting in amendments, protocol deviations, or multiple screening failures.

Methods: A retrospective audit of completed PaCCSC/CST protocol amendments from 2013-2023. Reasons for each amendment were assessed as being related to nursing input, or not. Items including: (1) questions around clarity, (2) scheduling issues (3) difficulties with the description of the intervention, (4) requirement for further explanation of data collection or assessment were classified as protocol issues potentially avoidable by early nursing review. Data were reported using descriptive statistics.

Results: A total of 17 study protocols were reviewed. The proportion of nurses listed as investigators on a protocol was 35% (n = 6). Of 70 amendments, 34% were related to nursing issues including study visits, data collection, implementation questions, inclusion/exclusion criteria, drug/randomisation, or assessments.

Conclusions: Several costly amendments may have been avoidable if nurse input had been included from inception. Further research is being undertaken to explore the role of nurses in protocol investigator teams and to understand the impact of the inclusion of a nurse in this role.

241 | A retrospective analysis of gemcitabine induced haemolytic uraemic syndrome in a single centre in Western Australia

Shane Fitzgerald¹, Dermot Farrell¹, Paul Burke¹, Leeona Gallagher¹, Adarsh Das¹, Andrew Dean¹

¹St John of God Subiaco Hospital, Subiaco, WA, Australia

Background: Gemcitabine is an antimetabolite used in the treatment of various malignancies, including pancreatic and ovarian carcinoma. Although it has a favourable toxicity profile, one of the rarer complications is haemolytic uraemic syndrome (HUS). HUS is characterized by microangiopathic haemolytic anaemia, acute kidney injury (AKI) and thrombocytopenia.¹ Gemcitabine-induced HUS (GiHUS) incidence has been reported to be between 0.008% and 0.078%.² GiHUS can easily be mistaken for treatment-related events such as myelosuppression from chemotherapy or AKI secondary to gastrointestinal losses. If not managed adequately, the sequalae from HUS can include end stage renal disease and neurological issues including coma, with mortality rates being up to 50%.³

Methods: An electronic database search was conducted, looking for patients receiving gemcitabine that developed HUS from February 2021 to February 2024. The patients’ records, pathology, radiology, and medication records were examined.

Results: Four patients were identified. Malignancies included were pancreatic adenocarcinoma (n = 2), endocervical adenocarcinoma (n = 1) and cholangiocarcinoma (n = 1). The median number of cycles to developing GiHUS was seven. Of note, one patient developed it after one cycle. They all presented with peripheral oedema, hypertension and investigations revealed AKI, thrombocytopenia, anaemia, and evidence of haemolysis on blood smear. All patients had normal ADAMTS13 levels and tested negative for Shiga Toxin-Producing Escherichia coli. They all received supportive care and either eculizumab (n = 3) or ravulizumab (n = 1) for their GiHUS. There were no significant complications with nil mortality reported, and they all went on to receive further lines of treatment without gemcitabine.

Conclusions: In our retrospective review, all patients recovered post treatment with no associated mortality. Early recognition and prompt treatment is essential to prevent the harmful sequelae of GiHUS. In patients treated with gemcitabine who present with peripheral oedema, hypertension, anaemia, thrombocytopenia, and AKI, gemcitabine should be withheld and prompt testing for HUS should be considered.

References:

1. Michael M, Bagga A, Sartain SE, Smith RJH. Haemolytic uraemic syndrome. Lancet. 2022;400(10364):1722-1740. doi: 10.1016/S0140-6736(22)01202-8. Epub 2022 Oct 19. PMID: 36272423.

2. Cidon EU, Alonso P. Gemcitabine induced hemolytic uremic syndrome: underestimated? Ann Oncol. 2018;29:v47-v48. doi: 10.1093/annonc/mdy151.168.

3. Lee HW et al. Gemcitabine-induced hemolytic uremic syndrome in pancreatic cancer: a case report and review of the literature, Gut and Liver. 2014;8(1):109-112. doi: 10.5009/gnl.2014.8.1.109.

242 | Prospective review of Pneumocystis Jiroveci pneumonia occurrence in the treatment of solid tumours in a single centre in Western Australia

Shane Fitzgerald¹, Dermot Farrell¹, Kate Flynn¹, Louise Dowling¹, Obi Johnson¹, Adarsh Das¹, Andrew Dean¹

¹St John of God Subiaco Hospital, Subiaco, WA, Australia

Background: Pneumocystis Jiroveci pneumonia (PJP) is a life threatening, opportunistic fungal infection, and commonly associated with patients that are immunocompromised such as HIV, post-cytotoxic chemotherapy and haematological malignancies. It is associated with significant mortality, with rates reportedly 30% 1-month post diagnosis in some series.¹ PJP has been increasingly found in patients undergoing first and second line chemotherapy. This is a prospective audit of thirteen cases of PJP in a single institution in WA.

Methods: Electronic patient records were reviewed to identify patients who developed PJP in our institution whilst on treatment with chemotherapy for solid tumours. The patients’ records, imaging, pathology, laboratory results and pharmacy records were reviewed.

Results: Thirteen patients were identified who developed PJP whilst on chemotherapy for solid tumours in our audit. These included pancreatic adenocarcinoma (n = 7), lung adenocarcinoma (n = 3), breast cancer (n = 2) and prostate adenocarcinoma (n = 1). Age of diagnosis ranged from 50 to 85 years old. Six patients had received first line treatment, and five had received second line at time of diagnosis of PJP. All cases were identified based on clinical context, changes on CT or positive sputum. Nine of the thirteen patients were lymphopenic on diagnosis, with counts of 0.2–1 (reference range 1.0–4.0 × 10⁹/L). All patients were HIV negative. Twelve were treated with high-dose sulfamethoxazole and trimethoprim, and one patient received atovaquone, followed by lifelong prophylaxis thereafter. One patient required intensive care support. Three patients died despite best management.

Conclusion: PJP is being more commonly diagnosed in earlier treatment lines than previously thought. With our cohort, nearly 85% of patients acquired it during first- or second-line treatment. The mortality rate in our cohort was just over 20%. Clinical suspicion of PJP should be considered in all patients presenting with acute respiratory illness whilst on chemotherapy regardless of the number of treatment lines received

Reference:

1. Shehbaz M. et al. Clinical characteristics and outcomes of Pneumocystis jirovecii pneumonia in cancer patients from a tertiary care hospital, Cureus [Preprint]. 2023. doi:10.7759/cureus.51291.

243 | Health-related quality of life (HRQoL) with tepotinib in patients with MET exon 14 (METex14) skipping non-small cell lung cancer (NSCLC) with brain, liver, adrenal or bone metastases in the phase II VISION trial

Stephanie Gasking¹, Niels Reinmuth², Julien Mazieres³, Sanjay Popat⁴, Luis Paz-Ares⁵, Emma Hook⁶, Anthony Hatswell⁷, Soetkin Vlassak⁸, Andreas Johne⁹, Helene Vioix¹⁰, Paul Paik¹¹

¹Merck Healthcare Pty. Ltd., Macquarie Park, Australia

²Asklepios Clinics Munich-Gauting, Department of Thoracic Oncology, Gauting, Germany

³CHU de Toulouse, Université Paul Sabatier, Toulouse, France

⁴The Royal Marsden Hospital, London, UK

⁵Hospital Universitario 12 de Octubre, Madrid, Spain

⁶Delta Hat, Nottingham, UK

⁷Delta Hat, Nottingham, UK

⁸Merck N.V.-S.A., Overijse, Belgium

⁹Merck Healthcare KGaA, Darmstadt, Germany

¹⁰Global Evidence and Value Development, Merck Healthcare KGaA, Darmstadt, Germany

¹¹Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA

Aims: Tepotinib, a highly selective MET inhibitor, showed robust and durable activity in patients with METex14 skipping NSCLC in the VISION trial (NCT02864992). Systemic and intracranial activity was seen in patients with brain metastases. We analysed HRQoL in patients with brain, liver, adrenal or bone metastases.

Methods: Eligible patients (including patients with brain metastases if asymptomatic or neurologically stable on a stable steroid dose) received oral tepotinib 500 mg (450 mg active moiety) once daily. HRQoL was assessed at baseline and during follow-up using the EORTC QLQ-C30 Global Health Score (GHS), EQ-5D-5L visual analogue scale (VAS), and EORTC QLQ-LC13 cough, dyspnoea, and chest pain scores. Subgroup analyses evaluated patients with brain, liver, adrenal or bone metastases at baseline per independent review (data cut-off: 20 November 2022). Mean change from baseline across all visits was evaluated by linear mixed model regression in patients with baseline and ≥1 post-baseline score.

Results: Of 313 enrolled patients, change from baseline in HRQoL was evaluable in 52 patients with brain, 56 with liver, 54 with adrenal, and 86 with bone metastases. At baseline, among all the evaluable patients, mean ± standard error (SE) EORTC QLQ-C30 GHS was worst in patients with bone metastases (49.90 ± 2.03), followed by patients with adrenal (51.85 ± 2.51), liver (58.33 ± 2.77), or brain metastases (59.94 ± 2.53). A similar pattern was observed for baseline EQ-5D-5L VAS (bone: 60.42 ± 1.94; adrenal: 63.06 ± 2.45; liver: 65.30 ± 2.46; brain: 66.75 ± 2.57). During tepotinib treatment, all patients with metastases maintained HRQoL and improved their symptoms, especially the patients with brain metastases.

Conclusion: In the VISION trial in METex14 skipping NSCLC, patients with brain, liver, adrenal or bone metastases maintained overall HRQoL during tepotinib treatment, with trends for improvement in cough, consistent with results for the overall population.

244 | Expanding the scope of transoral robotic surgery: Is it useful as a salvage technique in head and neck cancers?

Sahil Goel^1,2, Delu Gunasekera¹, Giri Krishnan¹, Suren Krishnan¹, John-Charles Hodge¹, Andrew Foreman¹

¹Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia

²JBI, School of Public Health, University of Adelaide, Adelaide, SA, Australia

Background: Traditionally, the management of recurrent, residual or second primary cancers (ReRuNe) in a previously radiation exposed field includes extensive open surgical techniques such as or mandibulectomy or pharyngotomy. These approaches have established correlations with significant morbidity, prolonged hospital stays and lengthy dependence on tracheostomy and gastrostomy tubes. Transoral robotic surgery (TORS) offers a minimally invasive approach reduces external dissection, improves post-operative recovery and decreases morbidity. The study looks at the effectiveness of this approach in ReRuNe populations and serves to identify the functional, oncological and survival outcomes in this cohort.

Methods: A systematic review of literature was undertaken from databases including PubMed, Embase and Scopus with two independent authors screening titles, abstracts and full texts against the inclusion and exclusion criteria. The search identified 679 studies with 552 remaining after duplicates were removed. After reviewing titles and abstracts, 61 articles were retrieved in full text form. Fifteen articles were included in the final study and a meta-analysis of proportions was conducted.

Results: Synthesised evidence included 515 patients across the 15 studies with TORS approach demonstrating a 2-year overall survival rate of 73.8% and a 2-year disease free survival rate of 56.1%. The mean tracheostomy decannulation time was a weighted mean of 17.7 days with long term dependence ranging in 0%−11.5% of patients. Positive surgical margins were obtained in 19.4% of patients with a pooled complication rate of 32.3%.

Conclusion: TORS is a promising salvage approach in head and neck cancers with similar survival and oncological outcomes whilst improving functional status and post-operative recovery for patients. Studies with further subgroup analysis on types of head and neck cancer, locations and procedures will further improve evidence base for this technique in the ReRuNe cohort.

246 | Longer-term safety and efficacy of selinexor maintenance therapy for patients with TP53wt advanced or recurrent endometrial cancer: Follow-up subgroup analysis of the ENGOT-EN5/GOG-3055/SIENDO study

Paul Haluska¹, Jose Alejandro Pérez-Fidalgo², Ignace Vergote³, Erika Hamilton⁴, Ugo de Giorgi⁵, Toon Van Gorp³, Kristina Lübbe⁶, Michael Zikan⁷, Limor Helpman⁸, David S. Miller⁹, Lorena Fariñas-Madrid¹⁰, Carmela Pisano¹¹, Annelore Barbeaux¹², Jalid Sehouli¹³, Hye Sook Chon¹⁴, Nerea Ancizar¹⁵, Jonathan Berek¹⁶, Pratheek Kalyanapu¹, Mansoor Raza Mirza¹, Vicky Makker¹⁷

¹Karyopharm Therapeutics, Newtown, MA, USA

²GEICO and Hospital Clinico Universitario de Valencia, INCLIVA, CIBERONC, Valencia, Spain

³Belgium and Luxembourg Gynaecological Oncology Group, Leuven Cancer Institute, University Hospitals, Leuven, Belgium

⁴Sarah Cannon Research Institute, Nashville, TN, USA

⁵IRCCS Istituto Romagnolo per lo Studio dei Tumori IRST, Meldola, Italy

⁶DIAKOVERE Henriettenstift Gynäkologie, Hannover, Germany

⁷Department of Gynecology and Obstetrics, Charles University - First Faculty of Medicine and University Hospital, Bulovka, Czech Republic

⁸Department of Gynecological Oncology, Sheba Medical Center, Tel-Hashomer, Israel

⁹Department of Obstetrics and Gynecology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, USA

¹⁰Vall d'Hebron Universitiy Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain

¹¹Istituto Nazionale Tumori di Napoli, Naples, Italy

¹²CHR, Verviers, Belgium

¹³NOGGO and Department of Gynecology, European Competence Center for Ovarian Cancer, Charité Comprehensive Cancer Center, Charité–Berlin University of Medicine, Berlin, Germany

¹⁴H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fl, USA

¹⁵GEICO andHospital Universitario de Donostia, Donostia, Spain

¹⁶Stanford Women's Cancer Center, Stanford Cancer Institute, University School of Medicine, Stanford, CA, USA

¹⁷Memorial Sloan Kettering Cancer Center, NYC, NY, USA

Background: Molecular characterization is important to inform treatment decisions for endometrial cancer (EC). Wild type TP53 (TP53wt) is found in ≥50% of advanced or recurrent EC; of those cases, 60%–78% are also categorized as proficient mismatch repair (pMMR). Evidence of benefit for these molecular subgroups is limited for patients with TP53wt tumours.

Methods: This was a long-term follow-up analysis of the prespecified TP53wt exploratory subgroup of ENGOT-EN5/GOG-3055/SIENDO (NCT03555422), a randomized, double-blind, phase 3 trial evaluating selinexor versus placebo as maintenance treatment for advanced or recurrent EC following response to prior systemic therapy.

Results: A total of 113 patients with TP53wt EC were randomized to selinexor (n = 77) or placebo (n = 36) as maintenance therapy. Median follow-up was 36.8 months; 15 patients remained on treatment as of 1 April 2024. Median progression-free survival (mPFS) was 28.4 months with selinexor versus 5.2 months with placebo (HR: 0.44; 95% CI [0.27–0.73], nominal one-sided p = 0.0005). PFS improvement was observed regardless of mismatch repair status; respective mPFS was 39.5 months versus 4.9 months in the TP53wt/proficient mismatch repair (pMMR) subgroup and 13.1 months versus 3.7 months in the TP53wt/deficient mismatch repair (dMMR) subgroup. Any-grade treatment-emergent adverse events (TEAEs) occurred in 99% and 94% of patients in the selinexor and placebo arms, respectively. The most common TEAEs were nausea (selinexor/placebo: 89%/40%), vomiting (61%/14%), and diarrhea (45%/37%); 17% of patients discontinued selinexor due to TEAEs. One death occurred in the placebo group.

Conclusions: TP53wt status may represent a robust predictive biomarker for selinexor efficacy in EC. A strong PFS signal was observed regardless of mismatch repair status, particularly in the TP53wt/pMMR subgroup, a patient population with high unmet need.

247 | Energy expenditure in head and neck cancer: A systematic literature review

Lauren Hanna¹, Kay Nguo¹, Teresa Brown^2,3, Judy Bauer¹

¹Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia

²Dietetics & Food Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

³School of Human Movement & Nutrition Services, University of Queensland, Brisbane, QLD, Australia

Aims: Cancer-associated malnutrition is prevalent in head and neck cancer (HNC). Nutrition interventions require accurate determination of daily energy needs, however predictive equations to estimate energy requirements may be inaccurate in people with cancer, and do not account for the influence of treatment. This review aims to synthesise evidence regarding energy expenditure in HNC to inform effective intervention delivery.

Methods: Four databases were searched in May 2024 to identify studies using reference methods (indirect calorimetry or doubly labelled water (DLW)) to measure resting or total energy expenditure (REE or TEE) in adults with any stage of HNC. Studies comparing to (a) non-cancer controls, (b) predictive equations, (c) wearable devices or (d) energy expenditure measured before and after treatment, were sought.

Results: 724 studies were screened, 11 studies (380 participants) were eligible for inclusion with varied HNC cancers where indirect calorimetry was used to measure REE. No studies measured TEE using DLW. Weight-adjusted REE was comparable to non-cancer controls in two studies (n = 48). Measured versus predicted REE was reported in eight studies; three studies reported hypermetabolism (measured/predicted REE ≥110%) in 25-57% of participants (n = 219). Measured REE at baseline was comparable to predicted REE in four studies (n = 53), and significantly lower than predicted in one study (n = 18). Seven studies measured REE before and after (chemo)radiotherapy treatment, with post treatment unadjusted REE comparable to baseline in two studies (n = 36), a U-curve in one study (n = 18), and significantly lower in four studies (n = 157); although not significant when REE was adjusted for weight and/or fat-free mass in two studies (n = 109).

Conclusions: Energy expenditure in patients with HNC was comparable to non-cancer controls and the accuracy of equations to predict REE varied. Further research with larger sample sizes and adjustments for body composition are needed to understand changes in energy needs during HNC treatment.

248 | Tumour heterogeneity and discordance of ER, PR and HER2 receptors between primary and recurrent breast cancer: A systematic literature review

Archana Haria¹, Kylie Mansfield¹, Jonathon Hill¹

¹University of Wollongong, Wollongong, NSW, Australia

Aim: Breast cancer is the most common cancer among Australian women and despite advances in prevention, early detection, and treatment recurrence rates remain at 25%–30%. This systematic literature review summarises the current evidence for ER, PR and HER2 discordance rates between primary and recurrent breast cancer, discordance impact on prognosis and evidence of primary tumour heterogeneity.

Methods: Web of Science, Scopus, MEDLINE and PubMed were searched with keywords ‘Breast Cancer’ AND ‘Primary’ AND ‘Recurrence’ AND ‘Discordance’ AND ‘Heterogen*’ or equivalent for publications from January 2013 to December 2023. The end points of interest were discordance rates, prognosis and evidence of tumour heterogeneity. Only studies with paired histopathology that employed immunohistochemistry were included.

Results: Searches identified 846 publications, of which 10 were eligible. All were retrospective cohort studies, two of which were prospectively planned. Average discordance rates for ER, PR and HER2 were 19.31%, 34.49% and 15.04% respectively. PR discordance was consistently the highest. ER and PR receptor loss were observed more frequently than gain. The opposite was true for HER2. ER and PR receptor loss were associated with a worse prognosis. Primary endocrine adjuvant treatment was associated with ER and PR loss. Receptor gain was associated with a better prognosis following treatment. Both intratumour and intertumour heterogeneity were observed.

Conclusions: We found discordance rates between primary and metastatic sites, suggesting resistant tumour clones and potential for poorer prognosis. Patients losing ER and PR had worse outcomes, while those gaining receptors responded well to treatment changes. We recommend re-biopsy of recurrent breast cancer, if feasible. Despite these insights, more research is needed to fully understand tumour heterogeneity and receptor discordance, which could significantly impact treatment and prognosis.

249 | Early cessation of adjuvant chemotherapy in WA patients with resected lung cancer – Determinants of early cessation and impact on outcomes

Teng Yik Hoo¹, Jacqueline Bentel^2,3, Glenn Boardmann³, Adrianna Gangemi³, Lydia Warburton³, Andrew Laycock^2,3, Linda Ye^1,2

¹SCGH, Nedlands, WA, Australia

²Royal Perth Hospital, Perth, WA, Australia

³Fiona Stanley Hospital, Murdoch, WA, Australia

Background: Adjuvant platinum-doublet chemotherapy following surgical resection of non-small cell lung cancer (NSCLC) reduces risk of relapse, however not all patients can complete this treatment. This project aims to explore the frequency and determinants of early cessation of adjuvant chemotherapy in the Western Australian population and possible impacts on clinical outcomes.

Methods: This retrospective study analysed patients who received at least one cycle of adjuvant chemotherapy following NSCLC resection within WA public hospitals between years 2015 and 2022. We identified patients who received four cycles versus ≤3 cycles of chemotherapy and disease-free survival (DFS) was compared using Kaplan–Meier and Cox proportional hazards analysis, adjusting for clinicopathological variables including age, sex, stage, histopathology and comorbidities.

Results: Among 129 patients, median age was 67 years old and 50% were men. Pathological tumour stage of the cohort was IIA (13%), IIB (46%), IIIA (36%) and IIIB (4%). 74% had adenocarcinoma, with 13% and 47% harbouring EGFR and KRAS mutation(s), respectively. Median time from surgical resection to chemotherapy commencement was 51 days. 86% of patients received cisplatin, with vinorelbine (63%), pemetrexed (16%) and etoposide (11%) being common partner agents. 75% of patients received four cycles, and 10%, 12% and 3% received three, two and one cycles, respectively. Primary reasons for treatment discontinuation were patient preference and treatment toxicity. There was no significant difference in the median DFS between patients receiving four cycles or <3 cycles of chemotherapy (27.8 vs. 22.3 months, p = 0.67). Amongst the variables investigated, only age was a predictor of non-completion of adjuvant chemotherapy.

Conclusion: In this Western Australian population, most patients were able to complete adjuvant chemotherapy, with the most common reasons for treatment discontinuation being patient preference and treatment toxicity. There was no difference in DFS between the two groups, however statistical power is limited by the small sample size.

250 | Skin adverse events of anti-cancer treatments: An examination of drug-adverse events associations

Kiarash Khosrotehrani^1,2, Samir Salah³, Cecile Pages⁴, Mario E. Lacouture⁵, Vincent Sibaud⁴

¹Experimental Dermatology Group, Faculty of Medicine, University of Queensland Frazer Institute, Brisbane, QLD, Australia

²Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia

³La Roche-Posay International, Levallois-Perret, France

⁴Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France, France

⁵Memorial Sloan Kettering Cancer Centre, New York, NY, USA

Introduction & Objectives: Although anti-cancer treatments, including chemotherapy (CTs), targeted therapies (TTs), radiation therapy, and immunotherapy (ITs), effectively treat cancer, they can cause significant skin-related toxicities (AEs). These toxicities can lead to discomfort and therapy discontinuation. This study investigated these associations using a large dataset.

Materials & Methods: The study utilised the US FDA Adverse Reporting System (FAERS) dataset, focusing on Healthcare Professional reports between January 2013−September 2022, encompassing 3,399,830 reports, 3084 drugs, and 16,347 AEs. To minimise false positives, we employed a nearest-neighbour matching model on demographics and severity criteria and addressed the inflation of error rates due to the multiplicity of tests.

Results: We identified 146 marketed anti-cancer drugs in the database with at least five reports of skin AEs. Of the 2757 drug-AE pairs, 708 displayed a significant reporting odds ratio (ROR) >1, involving 102 drugs and 135 skin AEs. Rash was significantly associated with 44 drugs and dry skin with 25 drugs. Methotrexate was significantly associated with 35 different AEs and anti-BRAF vemurafenib with 26 AEs. TTs were present in 57% of the pairs, CTs in 38%, and immune checkpoint blocking agents in 5%. Multikinase inhibitors were present in 15% of the pairs, followed by antimetabolites (14%).

Conclusion: This study used a large dataset to examine associations between cancer drugs and skin AEs. 146 anti-cancer drugs were found to have skin AEs, with rash and dry skin being the most reported AEs. TTs were most associated with skin AEs, followed by CTs. Methotrexate and vemurafenib had the most significant number of associations. These data don't allow evaluation of skin AE incidence with anti-cancer drugs as they are probably under-reported, but the findings do emphasise the importance of monitoring skin AEs in patients exposed to anti-cancer treatments.

251 | Holistic model of leukaemia survivorship care: Derived from a qualitative exploration of leukaemia survivorship

Shaun Kirsten¹, Rebekah Laidsaar-Powell¹, Joanne Shaw¹, Haryana Dhillon¹

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

Background: Increasing survival rates have left many leukaemia survivors with debilitating side- and late-effects. However, little is known about the persistent unmet needs of people living with leukaemia.

Aims: We aimed to qualitatively explore the experiences of individuals living with leukaemia and suitability of the Clinical Oncology Society of Australia's (COSA) Model of Survivorship Care (2016) to reflect leukaemia survivorship.

Methods: We used an inductive qualitative approach, conducting semi-structured interviews with leukaemia survivors recruited via social media and cancer advocacy organisations. Interviews were continued until information power was deemed appropriate. Reflexive thematic analysis (RTA) was used to describe and interpret key themes and meta-themes in the data. Overall findings were examined alongside the COSA Model.

Results: Twenty-four leukaemia survivors were interviewed, six themes were identified: (1) leukaemia is impactful, life-altering, and unexpected; (2) leukaemia is enduring, life-limiting, and uncertain; (3) survivorship is a team effort; (4) centrality of work as identity, focus, and financial security; (5) the dynamic landscape of coping; and, (6) survivorship as adjusting. Overall, participants described leukaemia survivorship as: (1) recursive; and (2) holistic. We identified key domains and stages common across leukaemia survivorship, represent them in our proposed Holistic Model of Leukaemia Survivorship (HMLS), arguing these are critical to the provision of quality survivorship care.

Conclusions: Our findings, while broadly corresponding with the COSA Model, demonstrate it lacks nuances specific to leukaemia survivorship. We recommended the HMLS be used to guide future leukaemia-specific development of the COSA Model and survivorship services.

255 | Pattern of access to genomically-linked therapies associated with pan-cancer biomarkers in advanced cancer patients: Insights from the Australian Molecular Screening and Therapeutics (MoST) program

Christine E. Napier^1,2, Frank Lin^3,4,5, Subo Thavaneswaran^3,4,6, Lucille Sebastian², John Grady^1,2, Maya Kansara⁷, Milita Zaheed^1,4, John Simes³, Mandy L. Ballinger^1,2, David M. Thomas^1,2

¹Centre for Molecular Oncology, UNSW, Sydney, NSW, Australia

²Omico, Sydney, NSW, Australia

³NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

⁴School of Clinical Medicine, UNSW, Sydney, NSW, Australia

⁵Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia

⁶The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia

⁷Genomic Cancer Medicine Laboratory, Garvan Institute of Medical Research, Sydney, NSW, Australia

Aims: Genomics reveals links to tumour-agnostic drug therapies targeting actionable alterations not accessible through histotype-based treatment. However, real-world access to genomically-matched therapy in Australia remains unknown.

Methods: This cross-sectional study analysed therapy access after comprehensive genomic profiling (CGP) via the Molecular Screening and Therapeutics (MoST) program, a nationwide precision oncology platform. The study focused on rare and less common cancers (RLCC) and treatment-resistant solid tumours and reports the patient proportion with therapeutically significant genomic alterations, including high tumour mutational burden (TMB-H), microsatellite instability (MSI-H), BRAF V600E and oncogenic alterations in ERBB2, NTRK1-3 and RET, and access to molecular tumour board (MTB)-based therapy recommendations. Follow-up data cut-off was June 2024.

Results: From September 2016-December 2023, 7013 patients had valid CGP results through MoST. Of these, 4978 (71%) received an MTB recommendation. Among the 3704 patients (53%) who received systemic therapy after MTB issue, 1040 (28%) received a matched therapy. Notably, 640 of these patients (62%) accessed matched therapy(s) through clinical trials (351/640 MoST-affiliated, 55%). Similarly, 705 of 2644 RLCC patients received matched treatment, with 457 (65%) through clinical trials (260/457 MoST-affiliated, 57%). Trial participation for pan-cancer biomarkers ranged from 19-38%, with the most common drug classes being immunotherapy and inhibitors of BRAF V600E and RET (Table 1).

Conclusion: Matched therapy access linked to pan-cancer biomarkers is not universal following molecular profiling. Clinical trial participation is essential to address this access gap for Australian patients.

256 | The use of durvalumab following definitive chemo-radiotherapy in unresectable stage III non-small-cell lung cancer – An experience of the Northern Adelaide Cancer Centre

Rama Devi Penumarty¹, Michelle Forgione¹, Dainik Patel¹, Christopher Hocking¹, Rohit Joshi¹, Vineet Kwatra¹

¹Medical Oncology, Northern Adelaide Local Health Network, Elizabeth Vale, South Australia, Australia

Background: The PACIFIC trial demonstrated a significant improvement in progression free survival (PFS) and overall survival (OS) with the addition of maintenance durvalumab following definitive chemo-radiotherapy (CRT) in patients with unresectable stage III non-small-cell lung cancer (NSCLC). Durvalumab maintenance following CRT became standard-of-care following in Australia in March 2021.

Objectives: The primary objective was to audit the rate of durvalumab uptake among patients who received definitive CRT for stage III unresectable NSCLC at the Northern Adelaide Cancer Centre. Secondary objectives were to compare PFS and OS between patients who received durvalumab and patients who did not receive durvalumab, and to establish the reasons for patients not receiving durvalumab.

Methods: This retrospective data was collected from patients who underwent definitive concurrent CRT for stage III unresectable NSCLC between 2021 and 2023 (n = 24). Patients with actionable EGFR, ALK or ROS mutations were excluded. Statistical analyses were performed using SPSS Software. Data cut-off date was 1 June 2024. Median follow-up time was 33.9 months.

Results: Of the 24 patients included in the final analysis, 10 received durvalumab maintenance therapy (41.7%), of which five completed the planned 12-month course. The most common reason for early discontinuation was disease progression (n = 3). Fourteen patients (58.3%) did not receive durvalumab. Common documented reasons for not receiving durvalumab included medical history or CRT-related toxicity (n = 4) and disease progression (n = 3). There was a numerical difference but not statistically significant difference between patients who received or did not receive durvalumab for median PFS (14.7 vs. 7.4 months, HR = 0.730, 95% CI = 0.219–2.435) and median OS (35.9 months vs. not reached, HR = 0.616, 95% CI = 0.149–2.539).

Conclusion: This audit identified a lower-than-expected uptake of maintenance durvalumab among patients with unresectable stage III NSCLC treated with concurrent CRT. However, approximately half the patients who were prescribed durvalumab completed the 12-month course, consistent with PACIFIC study.

257 | Peripheral neuropathy and hypersensitivity reactions from paclitaxel chemotherapy in patients with early breast cancer, experience in South-Western Sydney

Thi Thuy Duong Pham^1,2, Belinda Kiely^1,3, Sarah Childs¹

¹Medical Oncology, Campbelltown Hospital, Campbelltown, NSW, Australia

²Breast Cancer Trials, Newcastle, NSW, Australia

³Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia

Background: Peripheral neuropathy (PN) and hypersensitivity reactions (HSR) are frequent toxicities experienced by patients receiving paclitaxel chemotherapy.

Aims: To describe the frequency, nature and management of PN and HSR in early breast cancer patients receiving paclitaxel.

Method: A retrospective review of all patients with early breast cancer that received paclitaxel-based chemotherapy in three South Western Sydney hospitals from January 2021 to December 2023. The planned sample size was 300. Patient demographics and management strategies including dose reductions, dose delays and early cessation were recorded. Dose intensity of paclitaxel was calculated (dose planned/dose given) as well as the proportion of patients completing at least 80% of the planned treatment. Multivariable logistic regression was used to determine factors associated with PN and HSR.

Results: Of 345 patients, the median age was 53 years, 99% were female, 52.0% were non-Anglo-Celtic, 11% had diabetes and 6% pre-existing PN. Paclitaxel was administered weekly in 96% and with carboplatin in 16%. 248 patients (72%) had documented PN and 55% had PN grade documented (53% grade 1, 39% grade 2, 7% grade 3). PN resulted in: early cessation of paclitaxel in 23%; dose reduction in 28%; and dose delay in 4%. Cool gloves and socks were used in 10 patients (3%), and 12 (3%) were prescribed medication to treat PN. Pre-existing neuropathy was the only factor increasing the odds of stopping paclitaxel due to PN (OR 3.4, 95% CI 1.1–10.0, p = 0.03). HSR were recorded in 21% of patients, with 89% in the first 3 weeks. One patient required adrenaline and 6% stopped paclitaxel early due to HSR. Average paclitaxel dose intensity overall was 80%, and 72% completed 80% or more of the planned paclitaxel.

Conclusion: Most patients completed at least 80% of the planned paclitaxel with 29% ceasing early due to PN and HSR.

258 | Efficacy and safety of olomorasib (LY3537982), a second-generation KRAS G12C inhibitor (G12Ci), in combination with pembrolizumab in patients with KRAS G12C-mutant advanced NSCLC

Timothy F. Burns¹, Konstantin Dragnev², Yutaka Fujiwara³, Yonina R. Murciano-Goroff⁴, Dae Ho Lee⁵, Antoine Hollebecque⁶, Takafumi Koyama⁷, Philippe Cassier⁸, Antoine Italiano⁹, Rebecca S. Heist¹⁰, Ji-Youn Han¹¹, Dustin Deming¹², Alexander Spira¹³, Joshua Sabari¹⁴, Michael J. Chisamore ¹⁵, Aaron Fink¹⁶, Aaron Chen¹⁶, Melinda D. Willard¹⁶, Geoffrey R. Oxnard¹⁶, Natraj Reddy Ammakkanavar¹⁷, Aarohan Pruthi ¹⁸

¹Department of Medicine, Division of Hematology Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA

²Department of Hematology/Oncology, Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

³Aichi Cancer Center Hospital, Aichi, Japan

⁴Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA

⁵Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

⁶Gustave Roussy, Villejuif, France

⁷Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan

⁸Department of Medical Oncology, Centre Léon Bérard, Lyon, France

⁹Early Phase Trials Unit, Institut Bergonié, Bordeaux, France

¹⁰Massachusetts General Hospital, Boston, MA, USA

¹¹Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea

¹²Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

¹³Virginia Cancer Specialists, Fairfax, Farifax, VA, USA

¹⁴NYU Langone Health – Perlmutter & Long Island, New York, USA

¹⁵Merck & Co., Inc., Rahway, NJ, USA

¹⁶Loxo@Lilly, Stamford, Stamford, CT, USA

¹⁷Community Health Network, Indianapolis, IN, USA

¹⁸Eli Lilly, Indianapolis, IN, USA

Aim: Immunotherapy (IO), the established cornerstone of first-line treatment for KRAS-mutant NSCLC, has suboptimal outcomes. Here, we study pembrolizumab + olomorasib, a second-generation inhibitor of GDP-bound KRAS G12C, in NSCLC patients treated on LOXO-RAS-20001, a phase 1/2 study of olomorasib in KRAS G12C-mutant solid tumours (NCT04956640).

Methods: Patients with advanced KRAS G12C-mutant NSCLC (tissue/plasma) in any treatment line were eligible. Antitumour activity was studied in all patients who had ≥1, or had discontinued before the first, post-baseline response assessment.

Results: As of 30 October 2023, 50 eligible patients received 50–150 mg BID PO olomorasib + 200 mg Q3W pembrolizumab. During escalation, 2/6 patients treated at 150 mg BID developed grade ³3 LFTs, precluding further evaluation of this dose. In 44 patients (50/100mg BID), TRAEs ≥15% (related to olomorasib and/or pembrolizumab) were diarrhea (30%), ALT increased (20%), AST increased (18%); grade 3 TRAEs ≥10% were diarrhea (16%); pneumonitis was seen in three patients (grades 2/3/4). Due to TRAEs: 14% of pts had olomorasib dose reduction; dose hold in 27% (olomorasib) and 18% (pembrolizumab); 9% discontinued olomorasib or pembrolizumab; 9% discontinued both. Twenty-seven patients remain on treatment, and 17 discontinued treatment (10 due to PD, four due to AE). Among 30 efficacy evaluable KRAS G12Ci-naïve patients (60% IO/60% chemotherapy pre-treated) (median follow-up: 6 months [95% CI, 4–7]), ORR was 63% (15 PR/4 unconfirmed PR pending/ongoing; 95% CI, 44–80); DCR was 93% (28/30; 95% CI, 78–99); median PFS was not estimable (95% CI, 5-NE); ORR was 75% (9/12) in PD-L1 ≥50%, 56% (10/18) in PD-L1 <50%/unknown (three patients PD-L1 unavailable). In nine first-line patients, ORR was 78% (six PR/1 unconfirmed PR pending/ongoing; 95% CI, 40–97); DCR was 100%.

Conclusion: Olomorasib (50/100 mg BID) + pembrolizumab demonstrated favourable safety and antitumour activity in KRAS G12C-mutant advanced NSCLC. A global, registrational study investigating this combination in first-line NSCLC is currently enrolling (SUNRAY-01/NCT06119581).

259 | Intracranial Outcomes of 1L Selpercatinib in Advanced RET fusion-positive (RET+) NSCLC: LIBRETTO-431 study

Maurice Pérol¹, Ben J. Solomon², Koichi Goto³, Keunchil Park⁴, Ernest Nadal⁵, Emilio Bria⁶, Claudio Martin⁷, Jair Bar⁸, Justin Williams⁹, Tarun Puri⁹, Jian Li¹⁰, Minji Uh⁹, Boris Lin⁹, Caicun Zhou¹¹, Aarohan Pruthi⁹

¹Centre Léon Bérard, Lyon, France

²Peter MacCallum Cancer Institute, Melbourne, Australia

³National Cancer Center Hospital East, Chiba, Japan

⁴Samsung Medical Center, Seoul, South Korea

⁵Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain

⁶Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy

⁷Instituto Alexander Fleming, Buenos Aires, Argentina

⁸Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel

⁹Eli Lilly, Indianapolis, IN, USA

¹⁰Loxo@Lilly, Indianapolis, IN, USA

¹¹Shanghai Pulmonary Hospital, Shanghai, China

Selpercatinib, a highly selective, CNS active RET inhibitor is approved for treatment of advanced RET+ NSCLC. LIBRETTO-431 is the first study comparing intracranial (IC) efficacy of a targeted therapy to chemo/immunotherapy (IO) in patients with NSCLC.

LIBRETTO-431 (NCT04194944) is a randomized, phase 3 trial comparing 1L selpercatinib versus chemotherapy (cisplatin/carboplatin+pemetrexed) ± pembrolizumab. Primary endpoint of PFS by blinded independent central review (BICR) at the pre-planned interim analysis was met. IC analyses included CNS and non-CNS PD, IC PFS and IC responses by BICR per RECIST 1.1 in eligible patients. Adverse events were evaluated in the CNS safety population.

Of 261 patients, 192 were CNS-evaluable (selpercatinib: 120, control: 72). Baseline characteristics showed the selpercatinib arm having a slightly lower proportion of patients with BICR-assessed baseline brain mets (21% vs. 25%) and prior CNS radiotherapy (RT:6% vs. 10%) compared to the control arm. Selpercatinib delayed CNS PD as evidenced by a lower 12-month cumulative incidence rate (CIR) for CNS PD, as well as delaying non-CNS PD compared to control in patients with and without brain mets. In patients with measurable brain mets at baseline (n = 29), median time to IC response was similar between selpercatinib and control (1.4 vs. 1.6 months); previously reported IC response rates were higher (82% vs. 58%) and more durable (12-month DOR rate 76% vs. 63%) with selpercatinib versus control (Zhou et al. NEJM 2023). IC responses to selpercatinib were more common in patients without (93%) than with (50%) prior CNS RT.

Selpercatinib delayed IC progression in advanced RET+ NSCLC with/without baseline brain mets and achieved higher IC response compared to chemotherapy+pembrolizumab. LIBRETTO-431 demonstrated IC efficacy improvement of a targeted therapy versus chemo/IO in a biomarker-selected NSCLC population. These data further support selpercatinib as the preferred 1L regimen in patients with advanced RET+ NSCLC.

Previously presented at ASCO 2024.

260 | Health-related quality of life (HRQoL) and symptoms in LIBRETTO-431 patients with RET fusion-positive advanced non-small-cell lung cancer (NSCLC)

Caicun Zhou¹, Silvia Novello², Pilar Garrido³, Christophe Dooms⁴, Jorge Alatorre-Alexander⁵, Niels Reinmuth⁶, Adrienne M. Gilligan⁷, Nalin Payakachat⁷, Kim Cocks⁸, Gill Worthy⁸, Koichi Goto⁹, Aarohan Pruthi⁷

¹Shanghai Pulmonary Hospital, Shanghai, China

²Department of Oncology, AOU San Luigi, Orbassano, University of Torino, Torino, Italy

³Medical Oncology Department, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

⁴Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium

⁵Health Pharma Professional Research, Mexico City, Mexico, USA

⁶Asklepios Lung Clinic, member of the German Center for Lung Research (DZL), Munich-Gauting, Germany

⁷Eli Lilly, Indianapolis, IN, USA

⁸Adelphi Values, Bollington, Cheshire, UK

⁹Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan

LIBRETTO-431 (NCT04194944), a randomized phase 3 trial, compared first-line selpercatinib to platinum-based chemotherapy ± pembrolizumab. Selpercatinib is approved for the treatment of advanced RET fusion+ NSCLC. This analysis reported NSCLC symptoms and HRQoL from LIBRETTO-431.

Data were used (cut-off date: 1 May 2023) from the intent-to-treat (ITT) pembrolizumab subpopulation [selpercatinib (n = 129); chemotherapy + pembrolizumab (control, n = 83)] to assess time to confirmed deterioration (TTCD) of NSCLC symptoms (cough, dyspnoea, pain, fatigue, poor appetite using NSCLC-Symptom Assessment Questionnaire [SAQ]). TTCD of NSCLC symptoms were defined as time from randomization to the first score that met the pre-specified meaningful within-patient change thresholds, confirmed at next assessment. TTCD was compared between treatment arms using log-rank test and Cox proportional hazards model. Changes of NSCLC-SAQ total score (meaningful important difference [MID] ≥2 points) and HRQoL (using EORTC QLQ-C30 physical function (MID ≥6 points) and Global Health Status (GHS)/QoL (MID ≥5 points)) up to 1 year were evaluated and compared between the arms using a growth curve model and mixed model for repeated measures.

Selpercatinib significantly (p < 0.05) delayed TTCD of all individual symptoms with hazard ratio ranging from 0.41 (cough and pain) to 0.57 (dyspnoea), compared to control. Selpercatinib also showed a significant and clinically meaningful difference in the mean NSCLC-SAQ total score (difference = −2.0, p < 0.001) and physical function (difference = 8.1, p = 0.003) at 1 year, compared to control. GHS/QoL was improved in both arms with no difference in the mean scores between the arms at 1 year.

Selpercatinib significantly delayed TTCD of NSCLC symptoms and improved physical function compared to control in this patient population after 1 year of treatment. The findings were consistent with the favourable efficacy of selpercatinib compared with platinum-based chemotherapy + pembrolizumab and further support 1L use of selpercatinib in this population.

Previously presented at ASCO 2024.

261 | Efficacy of selpercatinib by RET fusion partner in RET+ NSCLC: Results from the LIBRETTO-001 and LIBRETTO-431 trials

Ben Solomon¹, Alexander Drilon², Keunchil Park³, Silvia Novello⁴, Ernest Nadal⁵, Benjamin Besse⁶, Nir Peled⁷, Patrick Peterson⁸, Scott Barker⁸, Anna M. Szpurka⁸, Olivera Grbovic-Huezo⁸, Herbert H. Loong⁹, Aarohan Pruthi⁸

¹Peter MacCallum Cancer Institute, Melbourne, Australia

²Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA

³Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

⁴University of Turin, AOU San Luigi-Orbassano, Italy

⁵Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain

⁶Institut Gustave Roussy, Villejuif, France

⁷Soroka University Medical Center, Beer-Sheva, Israel

⁸Eli Lilly, Indianapolis, IN, USA

⁹The Chinese University of Hong Kong, Hong Kong, China

Selpercatinib is a potent CNS active RET-inhibitor approved for treatment of advanced RET-driven cancers, including non-small-cell lung cancer (NSCLC). Here, the relationship between selpercatinib efficacy and RET fusion partner was examined in a combined cohort of untreated and previously treated patients from phase 1/2 LIBRETTO-001 (NCT03157128) and untreated patients from phase 3 LIBRETTO-431 (NCT04194944).

LIBRETTO-431 patients were included in a separate controlled analysis of selpercatinib treatment versus platinum/pemetrexed chemotherapy ± pembrolizumab (control), which was limited to KIF5B-RET due to low numbers of patients with other fusion partners. RET fusion partners were primarily identified in tumour tissue by NGS.

Of the 415 patients who received selpercatinib, 263 were previously treated for advanced disease. The most commonly identified RET fusion partners were KIF5B-RET (71.6%)/CCDC6-RET (21.2%). In KIF5B-RET fusions, the median PFS was 19.4 months (95% CI: 17.1–22.7), while mPFS was not reached CCDC6-RET fusions. The ORR in patients with KIF5B-RET and CCDC6-RET was 65.3% (95% CI: 59.6–70.7) and 83.0% (95% CI: 73.4–90.1) respectively. The median DOR was 20.3 months (95% CI: 17.5–23.9) in KIF5B-RET fusions, while not yet reached in CCDC6-RET fusions. Among LIBRETTO-431 patients, 44.0% (70/159) patients in the selpercatinib group and 49.0% (50/102) patients in the control group had KIF5B-RET. In KIF5B-RET fusions, the median PFS was 19.1 months (95% CI: 13.9–24.8) with selpercatinib compared to 7.4 months (95% CI: 4.9–11.2) with control.

In patients with RET+ NSCLC from LIBRETTO-001 and LIBRETTO-431, selpercatinib demonstrated robust and durable efficacy regardless of fusion partner. PFS in patients with KIF5B-RET from the LIBRETTO-431 control arm was consistent with prior reports of a poorer prognosis, regardless of treatment; however, clinical outcomes improved with selpercatinib versus chemotherapy ± pembrolizumab. These data support early and comprehensive genomic testing to identify RET fusions and use selpercatinib as the first-line therapy in patients with advanced RET+ NSCLC.

Previously presented at WCLC 2024.

262 | Dose adjustments and exposure-response associated with selpercatinib in patients with advanced non-small cell lung cancer (NSCLC)

Keunchil Park^1,2, Edurne Arriola³, Maurice Perol⁴, Caicun Zhou⁵, Koichi Goto⁶, Herbert Loong⁷, Scott S. Barker⁸, Ashish Massey⁸, Patrick M. Peterson⁸, Dan Liu⁸, Ayman Akil⁹, Ben J. Solomon¹⁰, Aarohan Pruthi⁸

¹Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

²Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

³Servei d'Oncologia, Hospital del Mar, Cancer Research Program IMIM-Hospital del Mar, Barcelona, Spain

⁴Department of Medical Oncology, Centre Léon Bérard, Lyon, France

⁵Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China

⁶National Cancer Center Hospital East, Chiba, Japan

⁷The Chinese University of Hong Kong, Hong Kong, China

⁸Eli Lilly, Indianapolis, IN, USA

⁹Certara USA, Inc., Princeton, NJ, USA

¹⁰Peter MacCallum Cancer Institute, Melbourne, Australia

Selpercatinib is a highly selective RET kinase inhibitor that has demonstrated improved progression-free survival (PFS) in patients with first-line RET fusion-positive NSCLC. This study examines selpercatinib outcomes with variable exposures resulting from dose adjustment.

NSCLC patients treated with selpercatinib in two prospective trials (LIBRETTO-001/LIBRETTO-431) were started at 160 mg BID; dose reductions to 120, 80, and 40 mg BID were permitted. Relationship between selpercatinib and efficacy endpoints (overall response rate [ORR] and PFS) were determined using exposure-response models. Steady-state exposure parameters selected for analysis (area under the plasma concentration-time curve over 24 h at steady state [AUC₂₄] and maximum and minimum selpercatinib concentrations) represented average selpercatinib exposure over time. Additionally, average exposure over the last 10 doses was considered.

Of 504 treated NSCLC patients (LIBRETTO-431, n = 150; LIBRETTO-001, n = 354), 266 underwent dose reduction. Median time to first dose reduction was 2 months. Patients with dose reduction tended to be older (median age 61 vs. 59 years) and had lower body weight (median weight 63 vs. 66 kg) and longer time on therapy (median time on treatment [95% confidence interval]: 31.7 vs. 21.2 months) versus patients without dose reduction. AST/ALT elevation, QT prolongation, and hypertension were the most common adverse events leading to dose adjustments. Focusing on 502 patients included in the ORR exposure-response analysis, the response rate was 69%; a stepwise multivariate logistic regression showed that probability of response increased with increasing selpercatinib AUC₂₄ (p < 0.05). Exploratory analysis of PFS in 504 patients (254 events) by exposure metrics showed no significant relationship with PFS across exposure quartiles.

No correlation found between drug exposure and PFS but did suggest that higher exposure was associated with better response rates. For patients experiencing toxicity on selpercatinib, dose adjustment to reduce exposure may allow ongoing clinical benefit without a decremental impact on PFS.

Previously presented at WCLC 2024.

263 | Upper-body function predicts breast cancer-related lymphoedema: Results from a prospective, population-based cohort study

Hildegard Reul-Hirche^1,2, Eeva-Liisa Laakso^3,4, Melanie Plinsinga¹, Matthew Dunn⁵, Melissa Troester⁵, Sandi Hayes⁶

¹School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia

²Physiotherapy Department, Royal Brisbane & Women's Hospital, Herston, QLD, Australia

³Mater Research Institute, University of Queensland, South Brisbane, QLD, Australia

⁴Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia

⁵Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA

⁶Cancer Council Queensland, Brisbane, QLD, Australia

Publish consent withheld.

264 | Service utilisation of the first hospital-based psychological service for carers of people with cancer

Ella Sexton¹, Peta Wright¹, Fiona Mouritz¹, Carmen Larkin¹, Maria Ftanou¹, Geraldine McDonald¹

¹Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Patient Experience and Wellbeing, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Psychosocial Oncology Program, Peter Mac, Melbourne, Victoria, Australia

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

Aims: Carers of people with cancer experience significant distress and up to 40% experience a diagnosable mental health problem yet very few services address this need. The aim was to evaluate utilisation and impacts of a pilot clinical psychology service to address the unmet needs of carers.

Methods: A carers clinical psychology service was established in March 2023 in metropolitan Melbourne. A retrospective file audit was conducted of service provision (referral rates, appointment number, presenting problem, intervention provided), carer and patient characteristics and psychological pre- and post-outcome data between 1 March 2023 to 29 February 2024. Service provision and carer and patient characteristic data were summarised as counts and percentages. Outcome data were analysed using t-tests.

Results: Seventy-four carers were referred to the clinic. Carers were predominantly female (74%) and caring for their spouse/partner (63%). A third of carers lived regionally. Common presenting concerns were anxiety, grief, low mood, and relationship difficulties. Common interventions provided were, cognitive behavioural therapy, acceptance and commitment therapy, existential intervention and communication skills training. Evaluation data showed that carers found the service acceptable. Pre- and post-outcome data indicated significant improvements in anxiety and depression and carer quality of life (M = 4.6, SD = 3.8, range = 1– 8, t(27) = 7.7, p < 0.001; M = 5.4, SD = 3.7, range = 1–15, t(27) = 5.6, p < 0.05; M = 6.1, SD = 1.4, t(27) = −3.8, p < 0.05).

Conclusions: Carers experience significant rates of psychological distress and impacts on quality life. Brief psychological intervention for cancer carers is accessible and acceptable. Preliminary data suggest psychological interventions for carers may improve mental health and quality of life, supporting carers to manage in their caring role.

265 | Comparing the outcomes of frail acute myeloid leukaemia patients undergoing systemic therapy to their fitter counterparts

Aaron Sia¹, Sakshi Chopra¹, Victoria Ling², Ruth Eleanor Hubbard^1,2, Peter Mollee², Emily Gordon^1,2, Leila Shafiee Hanjani¹

¹The University of Queensland, Brisbane, QLD, Australia

²Princess Alexandra Hospital, Brisbane, QLD, Australia

Background: Treatment of older persons with acute myeloid leukaemia (AML) presents a dilemma: intensive treatment carries significant risk of toxicity, but undertreatment can miss opportunities for remission or cure. Geriatric assessment (GA) to quantify frailty can improve outcomes in cancer care but data in AML is lacking. We conducted a systematic literature review to assess how the outcomes of frail patients with AML receiving systemic therapy differ from their fitter counterparts.

Methods: Two reviewers independently assessed papers from searches on PubMed, EMBASE, CINAHL and Web of Science. Studies were included if they were prospective, published in English, included patients aged >18 years with AML undergoing systemic therapy and conducted GA (either using a validated GA screening tool or assessments covering >2 geriatric domains). Frailty was defined as impairment on GA below reference ranges defined by individual papers. Baseline patient parameters, GA format and treatment outcomes were analysed. Quality was assessed using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale.

Results: 6644 studies were eligible for inclusion. 6628 studies were excluded after screening, leaving 16 studies for analysis. Studies were generally of low-moderate quality. Thirteen studies included patients undergoing intensive chemotherapy, seven undergoing low intensity therapies and two on best supportive care. Of ten studies exploring GA prognostic value, nine studies found GA was predictive of treatment outcomes: overall survival (n = 7), mortality (n = 3) and high grade toxicity (n = 1). This association persisted in the majority of studies after controlling for traditional disease risk factors such as age, comorbidities and molecular risk factors. One study found GA was not predictive of outcomes.

Conclusion: Frailty assessment has prognostic utility in AML complimentary to traditional disease risk factors. Whether routine implementation of GA can improve treatment outcomes in AML is unclear and represents a potential target of future research.

266 | Development of a self-reported frailty index − The SELFI

Aaron Din How Sia^1,2, Peter Mollee¹, Robyn Berry¹, Rahul Ladwa¹, Victoria Ling¹, James Fletcher^1,2, Emily Gordon^1,2, Euan Walpole^1,2, Leila Shafiee Hanjani², Natasha Reid², Camilla Simonsen¹, Ruth Eleanor Hubbard^1,2

¹Princess Alexandra Hospital, Brisbane, QLD, Australia

²The University of Queensland, Brisbane, QLD, Australia

Background: Routine implementation of geriatric assessment (GA) to quantify frailty improves outcomes in cancer care, yet time and resource barriers in fast-paced clinic settings often preclude implementation. A pragmatic GA delivery format balancing concision without compromising on detail is needed. We aim to develop a self-administered paper questionnaire, the SELFI, based on consumer feedback as a user-friendly tool able to provide a compendious frailty assessment at scale.

Methods: The short-form frailty index (FI) is a nurse-administered multidimensional GA tool validated in both oncology and non-oncology contexts. As part of a pilot phase, we converted the FI to a paper-based questionnaire intended to be completed by patients and their caregivers without staff input. The questionnaire was administered to cancer survivors attending a tertiary hospital oncology outpatient department. Feedback from users was elicited using ‘Think Aloud’ techniques, a validated method of questionnaire development, and was used to iteratively revise the questionnaire until feedback ceased to identify major issues for revision.

Results: Thirteen participants provided questionnaire feedback, informing 18 different questionnaire versions before completion of the revision process. Issues identified for revision included presentation (font size, colour scheme and order of presented items), semantic and grammatical phrasing of questions and simplification of medical jargon. The median time for questionnaire completion was 26 minutes (range: 10−43 min). Participant feedback was positive, with the questionnaire perceived as a useful tool to raise awareness about unmet needs.

Conclusion and future directions

The SELFI is a self-administered GA tool developed through an extensive revision process incorporating patient feedback. This tool will be now be validated against a nursing administered FI gold standard (phase 2). Once validated, it will offer an efficient way to quantify frailty in oncology settings and provide a route to GA implementation at scale.

268 | Feasibility of a structured telehealth intervention study lifestyle intervention (exercise and diet) for early-stage breast cancer survivors (LEAD-4-BCS) undergoing neo-adjuvant chemotherapy

Sim Yee (Cindy) Tan^1,2,3, Isaac Yeboah Addo², Gemma Collett⁴, Eliza R. Macdonald¹, Jane Turner¹, Shannon Gerber¹, Liane Lee², Hau Yi Yau², Sama Saleem³, Jasmine Yee⁴, Adrian Bauman⁵, Belinda E. Kiely¹, Natalie Taylor⁶, Richard De Abreu Lourenco⁷, Haryana Dhillon^4,8, Janette Vardy^1,2

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

²Faculty of Health and Medicine, The University of Sydney, Sydney, NSW

³Nutrition and Dietetics Department, Concord Hospital, Concord, NSW, Australia

⁴Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia

⁵School of Public Health, The University of Sydney, Sydney, NSW, Australia

⁶Implementation to Impact, School of Population Health, Faculty of Medicine and Health, UNSW, Sydney

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

⁸Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, Sydney, NSW, Australia

Background: Weight gain and physical inactivity during treatment for early-stage breast cancer are common.

Aim: To investigate the feasibility of delivering a virtual lifestyle intervention (exercise and diet) to breast cancer survivors (BCS) during chemotherapy.

Methods: Phase II single-arm study of supervised exercise and diet education sessions (1 h each/week) for 12 weeks. BCS (stages I–III) starting (neo)adjuvant chemotherapy, from 11 NSW sites (seven metropolitan, four regional) were eligible. Screening, intervention and assessments were conducted via telehealth. Assessments completed at: T0 = baseline, T1 = post-intervention, T2 = 3-months post-intervention. Primary outcome: adherence to individualised pre-set exercise and dietary goals. Secondary outcomes: acceptability (participation, attendance, completion), physical health, lifestyle outcomes.

Results: Of 73 referrals, 64 underwent screening with 60 BCS (82%) eligible, 58 (97%) consented and 51 (85%) started the intervention. Baseline characteristics for the 34 BCS completing the 12-week intervention (completion rate 67%): mean age 51 years (SD 8.8), body mass index 25.8 kg/m² (interquartile range 7.4), neoadjuvant chemotherapy (50%). Attendance was lower for exercise than diet sessions (65% versus 88% attended >50% of sessions). Of the 33 completing T1 assessment, 36% adhered to ≥50% of pre-set goals; 30% adhered to no goals. There was no significant difference in median weight pre- and post-intervention (p = 0.199) but a significant reduction in waist circumference (1.9 cm, p = 0.014), improvements in total time spent on exercise (median difference 38.5 min/week, p = 0.038), and average fruit (+0.5 serve) and vegetable (+0.9 serve) intake (p < 0.05). More participants met diet recommendations (fruit 33% vs. 3%, p = 0.02; vegetable 21% vs. 3%, p = 0.07) and exercise guidelines (18% vs. 6%, p = 0.125) post-intervention than baseline.

Conclusion: Our study did not meet its primary outcome (adherence rate >60%), but those completing the intervention attended at least half the diet and exercise sessions despite the challenges of concurrent chemotherapy. Results will inform the intervention design for a phase III study.

270 | A randomised controlled trial: Evaluating whether a cognitive-behavioural internet-delivered intervention targeting emotion regulation improves health-related quality of life in cancer survivors

Rebecca Wallace¹, Isabelle Smith¹, Daphne Day², Marliese Alexander³, Karen Weihs⁴, Joshua Wiley¹

¹Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia

²Monash Health, Melbourne, Victoria, Australia

³Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁴The University of Arizona, Tuscon, Arizona, USA

Aims: Cancer survivors experience reduced overall Health-Related Quality of Life (HRQoL) compared to the general population. This research assesses and compares the efficacy of an emotion focused (CanCopeMind) and lifestyle (CanCopeLifestyle) intervention to improve HRQoL among adults with a recent history of cancer of any type who finished planned primary cancer treatment (i.e., chemotherapy, radiation, surgery) ≤2 years prior.

Methods: This eight-week, internet-delivered, randomised controlled trial compared CanCopeMind (n = 110) and CanCopeLifestyle (n = 114) on self-reported HRQoL (range: −0.022 = indicating a state akin to ‘Dead’ to 1.0 representing ‘Perfect Health’) at baseline, post-intervention, and three-months follow-up. CanCopeMind, adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, targeted core emotion regulation skills (understanding emotions, mindfulness, flexible thinking, changing behaviours). CanCopeLifestyle, the active control, targeted healthy lifestyle domains (diet, exercise, relaxation, sleep).

Results: HRQoL increased in both groups from baseline to post-intervention (CanCopeMind: p < 0.001, SMD_median = 0.54; CanCopeLifestyle: p < 0.001, SMD_median = 0.40), and these improvements were sustained at follow-up (CanCopeMind: p< 0.001, SMD_median = 0.52; CanCopeLifestyle: p = .005, SMD_median = 0.33). The difference between each group was not significant at either post-intervention (p = 0.095, SMD_median = 0.19) nor follow-up (p = 0.081, SMD_median = 0.23). Subgroup analyses revealed no moderation by cancer stage, treatment type, months since treatment, cancer type, nor sex.

Conclusions: Findings indicate that an accessible, internet-delivered emotion-focused and lifestyle interventions hold promise for improving HRQoL among cancer survivors.

271 | Alpha-fetoprotein combined with initial tumour shape irregularity in predicting the survival of patients with advanced hepatocellular carcinoma treated with immune-checkpoint inhibitors: A retrospective multi-centre cohort study

Yong-Shuai Wang¹, Ji-Zhou Wang¹

¹Hepatobiliary Surgery, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Hefei, Anhui, China

Background & Aims: Immune checkpoint inhibitors (ICIs) are playing a significant role in the treatment of hepatocellular carcinoma (HCC). This study aims to explore the prognostic value of alpha-fetoprotein (AFP) combined with initial tumour shape irregularity in predicting the prognosis of patients treated with ICIs.

Methods: In this retrospective, multi-centre cohort study, 296 HCC patients received ICIs. Patients were randomly divided into the training set and the validation set in a 3:2 ratio. The training set was used to evaluate the impact of baseline factors on overall survival (OS) using the Cox model and to develop an easily applicable ATSI (AFP and tumour Shape Irregularity) score, which was then verified in the validation set.

Results: The ATSI score was developed from two independent prognostic risk actors: baseline AFP ≥ 400 ng/mL (HR 1.71, 95% CI 1.08 ∼ 2.73, p = 0.023) and initial tumour shape irregularity (HR 1.66, 95% CI 1.01 ∼ 2.75, p = 0.048). The median OS was not reached in patients who met no criteria (95% CI 28.20 ∼ NA), 25.80 months (95% CI 14.17 ∼ NA) in patients who met one criterion, and 17.03 months (95% CI 11.73 ∼ 23.83) in patients who met two criteria (p = 0.001). The median progression-free survival (PFS) was 10.83 months (95% CI 9.27 ∼ 14.33) for 0 points, 8.03 months (95% CI 6.77 ∼ 10.57) for 1 point, and 5.03 months (95% CI 3.83 ∼ 9.67) for 2 points (p < 0.001). The validation set effectively verified these results (median OS, 37.43/24.27/14.03 months for 0/1/2 points, p = 0.028; median PFS, 13.93/8.30/4.90 months for 0/1/2 points, p < 0.001).

Conclusions: The easily applicable ATSI score based on the baseline AFP levels and initial tumour shape can effectively predict efficacy and survival isn HCC patients with ICIs.

272 | Comparable dapsone dosing for PJP prophylaxis in cancer patients: Breaking down guidelines and building safer alternatives

Michael Whordley¹, Madeleine Washbourne¹, Sophie Alexander¹, Elizabeth Luo¹, Vivien Chan¹, Rachel Kim²

¹Pharmacy Department, Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia

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

Aim: To investigate the safety and efficacy of dapsone dosing for PJP prophylaxis in immunosuppressed patients undergoing cancer treatment.

Method: A retrospective audit at a single tertiary site was conducted between 1 January 2022 and 31 December 2023. Patients prescribed dapsone for PJP prophylaxis with a diagnosis of cancer and receiving cancer treatment were included. Cancer treatments included chemotherapy, immunotherapy, targeted therapy, bispecific T-cell engager (BiTE) therapy, glucocorticoids or a combination. Data collected included type of treatment, glucose-6-phosphate dehydrogenase (G6PD) deficiency, occurrence of breakthrough PJP infections, incidence of adverse drug reactions (ADRs), and concurrent use of strong CYP3A4 inhibitors. Data was extracted using digital records and analysed accordingly.

Results: Ninety-one patients were identified. Of this, seven patients received chemotherapy, five patients received immunotherapy, two patients received BiTE therapy, seven patients received glucocorticoids, and 70 patients received combinations of cancer treatments. G6PD deficiency screening had a 95.6% completion rate (n = 87) with one patient screened demonstrating a deficiency. Twenty-two patients (24.2%) were prescribed 100 mg once-daily, 68 patients (74.7%) were prescribed 100 mg twice-weekly, and one patient (1.1%) was prescribed 100 mg thrice-weekly. No patients were diagnosed with breakthrough PJP infections on any dosing regimen. There was a higher incidence of ADRs in the once-daily cohort at 50% (n = 11), with the twice-weekly cohort experiencing 14.7% (n = 10) (p-value = 0.029). Haemolytic anaemia, oxidative haemolysis and methemoglobinemia were the most common occurring of all cases. Concurrent use of strong CYP3A4 inhibitors were seen in 17 patients with two patients on twice-weekly dosing experiencing an ADR.

Conclusion: Twice-weekly dapsone dosing showed statistical significance for fewer ADRs compared to once-daily dosing for PJP prophylaxis. Twice-weekly dosing also demonstrated equal efficacy at PJP prophylaxis as once-daily dosing. Limited clinically significant interactions were identified despite the theoretical hypothesis of increased dapsone levels.

273 | Pro-health: Co-design of a remotely delivered nutrition and exercise web-program for men with prostate cancer on androgen deprivation therapy

Brenton Baguley¹, Robin M. Daly¹, Trish Livingston¹, Jonathan Rawstorn¹, Victoria White¹, Harriet Koorts¹, Steve Fraser¹, Jason Gardner¹, Lauren Atkins¹, Belinda Steer², Eric O³, Garrett Russell⁴, Gregory McNamara⁵, Nicole Kiss¹

¹Deakin University, Melbourne, VIC, Australia

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

³School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia

⁴Consumer representative, Prostate Cancer Foundation of Australia, Brisbane, QLD, Australia

⁵Consumer representative, Prostate Cancer Foundation of Australia, Sydney, NSW, Australia

Background: Access to nutrition and exercise services for men treated with androgen deprivation therapy (ADT) in prostate cancer varies widely across health services. This study aimed to co-design, with health professionals and consumers, a web-program with a suite of educational material to support remotely-delivered nutrition and exercise video-consultations for men treated with ADT.

Methods: Prostate cancer health professionals (n = 13; nurses, GP, dietitian, and exercise physiologists) and consumers treated with ADT (n = 9; mean ± SD, age: 69 ± 5.1 years; length on ADT: 3.4 ± 3.0 years) participated in two co-design workshops. Each workshop consisted of 4–9 participants, with seven workshops held in total. Co-design workshop one focused on the functional needs, preferences, and implementation considerations. Co-design workshop two used the MSCW (must, should, could, won't have) prioritisation method to determine the framework and structure, features, and functions. Workshops were recorded, transcribed, and summarised to inform the creation of the PRO-Health web-platform.

Results: Three themes emerged from workshop 1: (i) reduced inequalities: enabled improved access and availability of nutrition and exercise services, particularly for remote/regional groups, (ii) one-stop shop: the web-program must include safe, evidence-based, consumer approved, educational material, and (iii) implementation strategies: partner with NGO's, nurses to champion the program, embed shared care with practitioners for successful implementation. Workshop two features and functions include: (i) user-friendly interface: simple format, easy to navigate and find information; (ii) snack-sized educational material; practical, simple to follow information to address adverse effects from ADT and other treatments; (iii) personalised support: dietitians and exercise physiologists can individually develop personalised goals, dietary plans, exercise-programs with video instructions within PRO-Health to summarise recommendations.

Conclusion: Informed by consumers and health professionals, PRO-Health includes evidence-based content and individualised nutrition and exercise recommendations developed by health professionals to manage the adverse effects of ADT. Future work will involve user acceptance testing before piloting PRO-Health.

274 | Factors associated with bowel cancer screening participation of first nations peoples accessing home care services in New South Wales, Australia

Tsegaw Amare Baykeda¹, Shafkat Jahan¹, Kirsten Howard², Rakhee Raghunandan², Joan Cunningham³, David Currow⁴, Veronica Matthews⁵, Ian Olver⁶, Rebecca Ivers⁷, Gillian Harvey⁸, Tamara Butler¹, Nisreen Aouira¹, Amanda Hunter⁹, Sheree Bennett⁹, Gail Garvey¹

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

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

³Menzies School of Health Research, Melbourne, Victoria, Australia

⁴University of Wollongong, Wollongong, NSW, Australia

⁵Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

⁶Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia

⁷School of Population Health, University of New South Wales, Sydney, NSW, Australia

⁸College of Nursing and Health Sciences, Flinders University, Adelaide, NSW, Australia

⁹Australian Unity, Sydney, NSW, Australia

Background: Australia has been implementing the National Bowel Cancer Screening Program (NBCSP) for the past two decades to reduce deaths from bowel cancer by detecting the disease early. However, First Nations Australians’ participation rates have been lower than their non-First Nations counterparts and factors influencing bowel screening participation among First Nations Australians are poorly understood. Therefore, this study aimed to identify the factors associated with bowel cancer screening participation among First Nations people accessing home care services in New South Wales, Australia.

Methods: A cross-sectional study was administered by First Nation workers to First Nations clients of Australian Unity in New South Wales from June to September 2023. Multivariable logistic regression analysis was used to identify factors associated with bowel cancer screening participation. Adjusted odds ratio (aOR) with 95% confidence interval (CIs) was reported for significantly associated factors at p < 0.05.

Results: Out of 333 study participants, 72.07% (95% CI: 66.99–76.64) had ever participated in bowel screening. For every 1-year increase in age, the odds of participating in bowel screening increased by 1.08 times (95% CI: 1.03–1.30). Males were 59% less likely to participate in bowel screening compared to females (95% CI: 0.21–0.80). The odds of participating in bowel screening were 9.64 (95% CI: 4.91–18.93) and 2.28 (95% CI: 1.16–4.50) times among those who had ever been informed about bowel screening and those who had been given a bowel screening kit to do the test, respectively.

Conclusion: Whilst it is encouraging that approximately three-quarters of First Nations Australians have ever participated in bowel cancer screening, we can go further to reach more than a quarter of eligible First Nations who have never participated in bowel screening. This could be done by their doctors providing information on bowel cancer screening followed by giving a bowel screening kit to do the screening.

275 | Design principles for the development of equitable digital health technologies to support people with pancreatic cancer

Kara Burns¹, Kit Huckvale¹, Carrie Van Rensburg¹, Chathurika Palliya Guruge¹, Cecily Gilbert², Melanie Lovell³, Kylee Bellingham⁴, Nicole Rankin⁵, Mei Krishnasamy⁶, Gregory Crawford^7,8, Farwa Rizvi⁴, Jennifer Philip^4,9,10

¹Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, Australia

²Indigenous Health Research, Univeristy of Queensland, Brisbane, QLD, Australia

³Palliative Care, HammondCare, Greenwich, NSW, Australia

⁴Medicine, University of Melbourne, Parkville, VIC, Australia

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

⁶School of Nursing, University of Melbourne, Parkville, VIC, Australia

⁷Medicine, University of Adelaide, Adelaide, SA, Australia

⁸Palliative Medicine, Lyell McEwin Hospital, Modbury, SA, Australia

⁹St Vincent's Hospital, Fitzroy, VIC, Australia

¹⁰Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, VIC, Australia

Aims: No ‘one size fits all’ implementation strategy is possible for digital health technologies intended to support pancreatic cancer care across all Australian healthcare contexts. Thus, the aim of this research was to develop a set of principles that could act as flexible cues and be adapted to any primary, secondary, or tertiary care context to support the implementation of priorities under the National Pancreatic Cancer Roadmap, developed by Cancer Australia.

Methods: Development of the design principles involved a rigorous methodology combining multiple data sources and expert input. Initially, data from expert working groups and interviews with health IT professionals underwent conventional content analysis by two researchers, using an inductive grounded theory approach [4–6] allowing for the emergence of themes and patterns. To reduce the individual biases, two researchers independently developed a series of themes, then discussed divergence to agreement. A codesign focus group involving pancreatic cancer clinical, community, and consumer stakeholders was held. These experts provided peer-review and offered additional feedback, ensuring robustness and enriching the principles with their perspectives and experiences.

Results: Five principles were established to help embed equity in the development and implementation of digital health technologies for people with pancreatic cancer. These include: co-design with and for priority communities; design the service not the product; explore the data journey from end to end; incorporate non-digital fallbacks; and seek out existing, validated solutions and components.

Conclusion: The principles are not intended to replace project management approaches for digital health initiatives, nor to be an exhaustive catalogue of success factors. Instead, they are designed to act as flexible prompts to help teams working in pancreatic cancer care to consider and agree the overall approach to their digital health initiative and be guideposts to address equity as the project evolves.

276 | Co-designing resource-appropriate breast cancer guidelines for the Solomon islands: A collaborative approach with local and international experts

Lauren Canning¹, Andrew Soma², Rooney Jagilly³, Bianca Devitt⁴, Desmond Yip⁵, Matthew Links⁶

¹Fiona Stanley Hospital, Perth, WA, Australia

²Department of Medical Oncology, National Referral Hospital, Honiara, Solomon Islands

³Department of General Surgery, National Referral Hospital, Honiara, Solomon Islands

⁴Monash University, Melbourne, VIC, Australia

⁵Department of Medical Oncology, Canberra Hospital, Canberra, ACT, Australia

⁶Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia

Aim: To describe the process of co-designing resource-appropriate local cancer guidelines in the Solomon Islands, focusing on breast cancer management.

Methods: The process began with an initial draft, termed Prototype 1, developed by local and Australian experts, followed by a rapid literature review concentrating on existing and resource-adapted guidelines. The American Society of Clinical Oncology (ASCO) guidelines were chosen as the preferred template due to their broad applicability. A stakeholder consultation was conducted involving a local breast surgeon and oncologist, alongside content experts from Australia, to ensure the guidelines were contextually appropriate. Feedback from these consultations informed the development of Prototype 2. These revised guidelines will be pilot-tested in real-world settings within the Solomon Islands before requiring endorsement from relevant authorities, marking the completion of the development cycle.

Results: Existing guidelines offer broad guidance but necessitate local adaptation. Developing resource-appropriate guidelines involves more than adjusting for drug availability. The risks and benefits of treatment are heavily influenced by contextual factors, such as the availability of radiotherapy and supportive care for managing treatment toxicities. Standard practices, such as neoadjuvant chemotherapy, may not yield the same benefits in different contexts. Current guidelines often overlook person-cantered variables like access to care, and both direct and indirect costs, including opportunity costs. A significant advantage of the co-development process is the mutual and bidirectional learning it facilitates.

Conclusion: Developing resource-adapted cancer guidelines is crucial for promoting quality cancer care in low-resource settings. Each country's context is unique, necessitating a collaborative development process. Participation in guideline development allows COSA members to contribute to the global effort to improve cancer control.

277 | Queensland state-wide patterns and access to EGFR mutation testing for metastatic, non-squamous non-small cell lung cancer (non-SQ NSCLC) from 2014 to 2021

Navin Niranjan^1,2, Zane Yang ¹, Robert Mason^1,2, Tracey Guan³, Bryan A. Chan^4,5,6,7, Jasotha Sanmugarajah^1,2

¹Gold Coast University Hospital, Southport, QLD, Australia

²Griffith University School of Medicine and Dentistry, Southport, QLD, Australia

³Cancer Alliance Queensland, Woolloongabba, QLD, Australia

⁴Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia

⁵Centre for Bioinnovation, University of the Sunshine Coast, Sippy Downs, QLD, Australia

⁶Adem Crosby Cancer Centre, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia

⁷Griffith School of Medicine and Dentistry, Birtinya, QLD, Australia

Background: EGFR is the most common actionable genomic alteration in NSCLC. In late 2013, EGFR mutation testing was publicly funded for NSCLC. However, prompt EGFR results are not universally available, affecting equitable access to timely treatment.

Aims: To examine EGFR testing rates over time and factors impacting results and timeliness of outcomes.

Methods: This was a retrospective audit of 3827 patients between 2014 and 2021 identified via the Queensland Oncology Repository. Primary outcomes were EGFR mutation testing rates and time from first sampling to result, stratified by year of diagnosis and rurality.

Results: Of patients identified 458 were excluded (329 due to publicly unavailable EGFR results and 129 due to incorrect listing as non-SQ NSCLC). Of the 3369 cases included, 2871 (85.2%) had EGFR testing. An EGFR mutation was detected in 12.6% of cases. For cases without conclusive EGFR results, reasons included: 179 transitioned to best supportive care, 208 with insufficient tissue, and 155 for unclear reasons.

Mean time from sampling to EGFR result improved from 29.9 to 21.5 days between 2014 and 2021, with no significant difference based on rurality. The rate of cases with no EGFR results improved from 23.7% in 2014–2015 to 11.0% in 2020–2021.

Cases with inconclusive EGFR results were more prevalent rurally. Of patients from outer regional/remote areas 21.1% had an inconclusive result, compared to 15.5% from major cities/inner regional sites. This was a significant relative increase of 36.2% (95% CI: 10.1%–68.6%, χ² = 7.7483, p = 0.005). Cases with inconclusive EGFR results in outer regional/remote sites declined from 30.1% in 2014–2015 to 15.3% in 2020–2021.

Conclusions: EGFR mutation testing and mean time to results have improved from 2014 to 2021. Although time to result was not affected by location, significantly more rural patients lacked conclusive EGFR results, highlighting the need for further process and quality improvement to ensure equitable care state-wide.

Reference:

1. Credit Line: 2024 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the [2024 ASCO Annual Meeting]. All rights reserved.

278 | Bridging the gap: Understanding the sociodemographic disparities in access to early prostate cancer detection in Australia

Rani R.R.C. Chand¹, Karen K.C. Chiam¹, Visalini V.N.S. Nair-Shalliker¹, Jeff J.D. Dunn², Peter P.H. Heathcote², David D.S. Smith¹

¹Daffodil Centre, Sydney, NSW, Australia

²Prostate Cancer Foundation of Australia, NSW, Australia

Aims: In Australia, while prostate cancer (PC) diagnosis and treatment are influenced by demographic, cultural, and geographic factors, the impact of sociodemographic factors on access to early detection is not well explored. This study aims to describe how inequalities affect access to PSA testing across various priority populations in Australia, highlighting gaps and barriers that may impact understanding and access to early detection.

Methods: A narrative review was conducted to identify equity issues in accessing PSA testing among Australian priority populations, including Aboriginal and Torres Strait Islander people, individuals with African ancestry, Culturally and Linguistically Diverse (CALD) populations, and rural and regional/remote areas. Relevant sources, including peer-reviewed publications, websites, and reports, were retrieved from January 2010 to July 2024 using databases and search engines such as PubMed and Google. Outcome measures included incidence, mortality, PSA testing, patterns of care, and attitudes toward testing.

Results: Over 100 sources were reviewed. In Australia, individuals in major cities, aged 50-59, with higher education and private health insurance are more likely to participate in PC screening via PSA testing.^1,2 Data revealed that PC incidence and mortality rates were higher in regional and rural areas compared to major cities.³ Between 2017 and 2021, the age-standardised PC mortality rate in NSW was higher in remote areas (34.9 per 100,000) compared to major cities (18.7 per 100,000). These disparities may stem from variations in patient management practices, healthcare access, and socioeconomic factors.⁴

Equity issues affecting healthcare access were identified, including inadequate community awareness, low health literacy, and travel-related barriers. There is a notable lack of comprehensive evidence on PC outcomes, early detection, or healthcare uses for individuals with African ancestry and CALD populations.

Conclusions: Our review highlights the need for strategies that ensure equitable access to culturally appropriate information and services to improve PC outcomes across Australian priority populations.

References:

1. Kohar A, Cramb SM, Pickles K, et al. Changes in prostate specific antigen (PSA) ‘screening’ patterns by geographic region and socio-economic status in Australia: analysis of medicare data in 50–69 year old men. Cancer Epidemiol. 2023;83:102338. https://doi.org/10.1016/j.canep.2023.102338

2. Nair-Shalliker V, Bang A, Weber M, et al. Factors associated with prostate specific antigen testing in Australians: Analysis of the New South Wales 45 and up study. Sci Rep. 2018;8(1):4261. https://doi.org/10.1038/s41598-018-22589-y

3. Yu XQ, Luo Q, Smith DP, et al. Geographic variation in prostate cancer survival in New South Wales. Med J Aust. 2014;200(10):586-590. https://doi.org/10.5694/mja13.11134

4. Cancer Institute NSW. Detailed cancer incidence, mortality and survival statistics. Retrieved August 7, 2024, from https://www.cancer.nsw.gov.au/research-and-data/cancer-data-and-statistics/data-available-now/cancer-statistics-nsw/cancer-incidence-mortality-survival/detailed-cancer-incidence-mortality

279 | Delays in commencing radiotherapy and systemic therapy for gynaecological cancer patients in regional New South Wales

Angela Chen¹, Carmen Hansen², Jessica Dortmans³

¹The University Of New South Wales, Port Macquarie, NSW, Australia

²Northern NSW Cancer Institute, Tweed Valley, Tweed Heads, NSW, Australia

³Mid North Coast Cancer Institute, Port Macquarie, Port Macquarie, NSW, Australia

Aims: Australia's Cancer Council has produced Optimal Care Pathways (OCP) to guide the delivery of collaborative, equitable and evidence-based cancer care. This study aims to assess adherence to OCP guidelines with respect to the time from multidisciplinary meeting (MDM) to commencement of radiation (RT) and/or systemic therapy (ST) and investigate any factors associated with delayed start.

Methods: A clinical audit was undertaken of patients treated through the Mid North and North Coast Cancer Institutes with care plans for gynaecological cancers (ICD10 codes 51-56) from 2013 to 2023. Dates for MDM and start of RT and/or ST were identified. The time elapsed was compared to OCPs to assess adherence; for vulvovaginal cancers which lacks an Australian OCP, the NHS 60day best practice pathway was used.

Results: Three hundred and ten cases were analysed. Across all cancer types, 41.46% of patients met the guidelines for start of systemic therapy compared to 42.36% of radiotherapy patients. Despite these proportions being similar, the mean wait time to commence RT was 11.952 days longer than that for ST (95% CI 2.651–21.253, p = 0.012). For ST, cervical, uterine and ovarian cancer patients were more likely to meet guidelines than vulvovaginal (OR 2.19, 8.3 and 4.19, respectively). Compared to patients with vulvovaginal cancers, cervical and uterine cancer patients were 3.26 and 16.99 times, respectively, more likely to meet OCP guidelines for start of RT. This study finds that patient age and distance from cancer institute were not associated with delayed care.

Conclusions: The adherence to these OCP guidelines can be improved for all gynaecological malignancies. Vulvovaginal cancer patients are least likely to meet their respective guidelines and will benefit from a specific Australian OCP. Factors contributing the longer wait times from MDM to RT and poor adherence to vulvovaginal care guidelines should be explored, with the aim of enhancing equitable and evidence-based care.

280 | How does the health system support advance care planning with culturally and linguistically diverse communities? A document analysis

Upma Chitkara¹, Reema Harrison¹, Ramya Walson¹, Ashfaq Chauhan¹, Ursula Sansom-Daly^2,3,4

¹Macquarie University, Macquarie Park, NSW, Australia

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

³School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, University of New South Wales, Sydney, NSW, Australia

⁴Sydney Youth Cancer Service, Prince of Wales Hospital, Nelune Comprehensive Cancer Centre, Randwick, Sydney, NSW, Australia

Aim: Advance Care Planning (ACP) occurs less frequently with people from culturally and linguistically diverse (CALD) backgrounds exposing them to care that does not align with their preferences, wishes and needs at the end of their life. Resources designed to facilitate ACP are plentiful but disparately distributed in the Australian healthcare system. This study aimed to provide an evidence synthesis to determine the availability and scope of resources that aim to facilitate ACP among people from CALD backgrounds.

Methods: Altheide's document analysis approach was used to systematically search and select eligible resources (published between January 2013 and June 2023, publicly available through websites of government health departments and registered non-government organisations and focused on facilitating ACP with people from CALD backgrounds). A narrative synthesis was conducted using the International Association for Public Participation's consumer engagement framework to report on the characteristics and scope of resources.

Results: A total of 31 documents were identified; 22 documents (71%) originating from federal government sources and 18 (58%) at the state level. Twenty-two (71%) documents were targeted to be used by people from CALD backgrounds, eight (25%) by healthcare staff and only one that was developed to be used by both parties. Sixteen documents were available in a language other than English, covering 90 community languages. Five documents were available in easy-to-read English versions. Twelve documents provided guidance to CALD communities on leading conversations with healthcare staff about ACP, focusing on practical tips to go through the process (think, talk, write, share) and/or providing specific communication examples.

Conclusions: There is plethora of resources available to facilitate ACP among CALD communities, although few provide resources to facilitate staff, patients and families to collaborate together. Evidence of the barriers to engaging with these resources towards greater ACP uptake would be beneficial.

281 | Compassionate access drug use for oncology treatment: Single institution retrospective audit 2017–2024

Yun San Chong¹, Grace Redmayne², Melvin Chin^1,2

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

²Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia

Background: The Pharmaceutical Benefits Scheme (PBS) provides affordable access to cancer treatments in Australia. Not all treatments needed by patients are on the PBS. An alternate access to non-PBS oncology drugs is through Compassionate Access Programs (CAPs), organised by pharmaceutical companies. This retrospective audit describes oncology drugs used via CAPs at a single cancer centre in Sydney. A previous audit covered the period 2011–2015.¹

Methods: Cases of patients with solid tumour diagnoses who were organised to receive free drugs between 1 January 2017 and 31 July 2024 were found using pharmacy administrative records. Further information was extracted from hospital medical records. Cases of haematological malignancy, including lymphoma, and patients on post-clinical trial access were excluded. CAPs were grouped into co-pay/cost-share and cost-free programs.

Results: Of 237 cases, 160(67.5%) received the drug cost-free and 77(32.5%) were on a cost-share program. 117(49.4%) patients received the CAP drug as their first therapy. The median number of previous therapies prior to receiving CAP drug was 0 (range: 0–4 therapies). The median duration between diagnosis and use of CAP drug was 11.3 months (range: 7 days–8.2 years). The median and mean duration of CAP drug use was 4.9 and 9.7 months respectively (range: 1 day–83.8 months). A total of 50 programs provided 40 drugs from 18 companies. Four drugs had both co-pay and cost-free programs for different indications. The program with the most patients (n = 43) was for a Her2 monoclonal antibody. The next most used programs were for PD1 monoclonal antibodies (n = 33, 22). Some patients enrolled on cost-share programs did not continue for sufficient cycles to receive free drugs.

Conclusions: CAP use has increased significantly compared to the earlier audit. The proportion of patients on cost-share to cost-free programs was similar.

Reference:

1. Chin TTC, Botes LLB, Chin MMC. Compassionate supply of oncology drugs within the South Eastern Sydney Local Health District (SESLHD) in 2011–2015, Asia-Pacific J Clin Oncol. 2017;13(S4):188-188.

282 | The receipt of surgery versus radiation therapy by Aboriginal and Torres Strait Islander people diagnosed with prostate cancer in NSW

Mei Ling Yap^1,2,3,4, Rebecca Murray³, Gabriel Gabriel^5,6, Joseph Descallar^5,6, Susan Anderson⁷, Geoff Delaney^1,3, Viet Do^3,6, Karen Wong^3,6, Henry Woo^8,9, Keziah Bennett-Brook¹⁰, Julieann Coombes¹⁰

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

²The Cancer Program, The George Institute for Global Health, Barangaroo, NSW, Australia

³Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia

⁴School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

⁵Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

⁶South-West Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia

⁷Aboriginal Consumer, Sydney, NSW, Australia

⁸Department of Urology, Blacktown & Mt Druitt Hospitals, Blacktown, NSW, Australia

⁹Department of Uro-oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia

¹⁰Guunu-maana (Heal) Aboriginal & Torres Strait Islander Health Program, The George Institute for Global Health, Barangaroo, NSW, Australia

Aims: Prostate cancer is the most common cancer diagnosed in Aboriginal and Torres Strait Islander men. Surgery and radiotherapy are curative options which lead to equivalent survival but different side effects and financial costs. We aim to determine the uptake of surgery and/or radiotherapy for prostate cancer by First Nations people within NSW.

Methods: This was an individualised patient linked-data study which used the NSW Cancer Registry (to Dec 2018), NSW Admitted Patient Data Collection (to Dec 2021), Outpatient Radiation Oncology Data (Dec 2020) and Register of Births Deaths and Marriages (to March 2021). Multivariable proportional hazards models were used to estimate cause-specific hazards separately for time to radiotherapy and time to prostatectomy with a competing risk of death.

Results: There were 60037 people diagnosed with prostate cancer between 2009 and 2018; 1061(1.8%) were First Nations people. The median follow-up for the cohort was 6.3 years. A total of 22945 (41.4%) patients received a prostatectomy; in the First Nations population, it was lower at 362(36.6%) patients. A total of 17,196(31.0%) received radiation therapy and for First Nations people, 349 (35.2%) received radiotherapy. First Nations people received surgery in public hospitals (n = 275, 76%) more commonly than the rest of NSW (n = 12868, 57%). In multivariable analysis, First Nations people were less likely to receive a radical prostatectomy (HR 0.9 p < 0.05) than the rest of the NSW population. Other factors associated with less uptake included not holding private insurance and lower area-level socio-economic status. First Nations people were more likely to receive radiotherapy (HR 1.2, p < 0.001).

Conclusion: First Nations people are more likely to receive radiotherapy but less likely to receive surgery for prostate cancer, than the rest of the NSW population. Given the increasing privatisation of cancer care in Australia, it is imperative there is equitable access to treatment options for First Nations people.

284 | Longitudinal multidisciplinary intervention (LMI) during the entire disease trajectory improves long-term outcomes in younger patients with metastatic colorectal cancer: A retrospective analysis in the Australian context

Prasad Cooray¹, Ashleigh Poh², Raffiela Garcia², Caroline Le²

¹Yarra Oncology, Ringwood East, VIC, Australia

²Epworth Healthcare, Melbourne, VIC, Australia

Background: Colorectal cancer (CRC) among younger patients is rapidly increasing globally. Many are diagnosed at an advanced stage, leading to poor outcomes, with 13% achieving long-term survival. Integrating systemic therapy with surgical resection, locally ablative therapies, and repeat multidisciplinary assessments has shown improved outcomes, as evidenced by the RAXO studies.^1,2 We evaluated whether a similar approach can yield comparable outcomes in an Australian context.

Methods: We conducted a retrospective audit of patients diagnosed with metastatic CRC under the age of 55, treated in our practice from 2016, with a minimum follow-up of 18 months as of May 31, 2024. Data were collected from electronic medical records.

Results: Thirty-seven patients were eligible, with median follow-up of 48 months. Disease distribution was M1a (32%), M1b (49%), M1c (19%). Radical intent treatment was achieved in 65% of patients. Among these, the 4-year survival rate was 75%, with 89% of alive patients achieving minimal residual disease (MRD) or no evidence of disease (NED). Excellent survival outcomes were possible for both M1a and M1b patients with 4-year survival rates 78% and 84% and MRD/NED rates 88% and 90% respectively. Patients with RAS/RAF wild-type tumours had a 4-year survival of 75%, compared to 29% for those with either mutated tumours.

Conclusion: LMI integrating optimal systemic therapy, resection, and ablative therapies significantly improve long-term outcomes for younger patients with mCRC. They align well with the outcomes observed in the RAXO studies. Significant differences in outcomes are apparent between RAS/RAF wt versus either mutated subgroups. Both M1a and M1b subgroups achieved exceptional survival outcomes. Intent and conversion were deliverable. This data highlights the importance of a comprehensive LMI strategy in managing mCRC in younger patients during the entire disease trajectory, suggesting that such an approach can be effectively implemented in different healthcare settings.

References:

1. Osterlund P, Salminen T, et al. Repeated centralized multidisciplinary team assessment of resectability, clinical behaviour, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): a nationwide prospective intervention study. Lancet Reg Health Eur. 2021;3:100049. doi: 10.1016/j.lanepe.2021.100049. PMID: 34557799; PMCID: PMC8454802

2. Uutela A, Osterlund E, et al. Resectability, conversion, metastasectomy and outcome according to RAS and BRAF status for metastatic colorectal cancer in the prospective RAXO study. Br J Cancer. 2022;127(4):686-694. doi: 10.1038/s41416-022-01858-8. Epub 2022 May 24. PMID: 35610367; PMCID: PMC9381729.

285 | A call for national young onset colorectal cancer roadmap

Prasad Cooray¹

¹Yarra Oncology, Ringwood East, VIC, Australia

The incidence of colorectal cancer (CRC) in younger people is rising rapidly worldwide, with Australia having the highest rates. This cohort faces delayed diagnosis, resulting in late-stage presentation and is the cause of highest mortality among young adults in Australia. The burden of young-onset CRC (yo-CRC) extends beyond the individual, impacting families, society, and the economy. Viewing yo-CRC as a distinct entity can address its unique challenges and improve outcomes.

Historically, metastatic CRC in younger populations has had poor survival rates, ranging from 13% to 23% at 5 years. However, a coordinated, comprehensive approach could significantly improve outcomes. We propose a holistic care model that surrounds the patient with various support systems, including care navigators, exercise physiology, mental health support, fertility preservation, survivorship care, and post-treatment surveillance. Multidisciplinary teams (MDTs) with expertise in managing yo-CRC should be accessible, and patients should be involved in MDT discussions.

Dedicated, real-time registry for yo-CRC, the Registry of Incidence, Interventions, and Outcomes (RIIO), is proposed to collect comprehensive data, drive research and establish feedback mechanisms for MDTs. This registry would facilitate rapid adaptation of treatments, improve outcomes, and foster research collaboration.

There are significant disparities in clinical practice affecting young patients, particularly those with metastatic CRC. With the incidence of yo-CRC expected to increase, there is an urgent need for a national roadmap to address this challenge comprehensively, optimising existing care elements and implementing new changes.

Key elements include understanding causative factors, developing targeted screening guidelines, minimising treatment toxicity, ensuring fertility preservation, reviewing advanced stage disease treatment, and establishing a national registry. Additionally, care navigators and post-treatment surveillance incorporating circulating tumour DNA (ctDNA) could significantly enhance patient care. Addressing palliative care needs and improving survivorship programs are also crucial. The proposed roadmap aims to redefine cancer care for yo-CRC patients and improve outcomes for future generations.

References:

1. Spaander MCW, Zauber AG, Syngal S, et al. Young-onset colorectal cancer. Nat Rev Dis Primers. 2023;9(1):21. doi: 10.1038/s41572-023-00432-7. PMID: 37105987; PMCID: PMC10589420

2. Boyce S, Nassar N, Lee CY, Suen MK, Al Zahrani S, Gladman MA. Young-onset colorectal cancer in New South Wales: a population-based study. Med J Aust. 2016;205(10):465-470. doi: 10.5694/mja16.00237. Erratum in: Med J Aust. 2016 Dec 12;205(11):508. PMID: 27852185.

3. Lamprell K, Pulido DF, Arnolda G, et al. People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia and New Zealand. BMC Prim Care. 2023 Jan 14;24(1):12. doi: 10.1186/s12875-023-01967-0. PMID: 36641420; PMCID: PMC9840343.

4. Wormeli P, Mazreku J, et al. Next generation of central cancer registries. JCO Clin Cancer Inform. 2021;5:288-294. doi: 10.1200/CCI.20.00177. PMID: 33760641

5. Yan MK, Adler NR, et al. Opportunities and barriers for the use of Australian cancer registries as platforms for randomized clinical trials. Asia Pac J Clin Oncol. 2022;18(4):344-352. doi: 10.1111/ajco.13670. Epub 2021 Nov 23. PMID: 34811922

286 | Pregnancy-associated colorectal cancer in Australia: A consumer-initiated qualitative case series

Prasad Cooray¹, Sophie Boffa¹, Makala Ffrench Castelli², Emily Andrew³

¹Yarra Oncology, Ringwood East, VIC, Australia

²Oncana, Brisbane, Australia

³University of Melbourne, Melbourne, Australia

Pregnancy-associated cancer refers to diagnosis during pregnancy or within the first year postpartum.¹ With rising maternal age and increasing young-onset colorectal cancer (yo-CRC), there is a notable increase in pregnancy associated CRC (pa-CRC) cases. This, coupled with delayed diagnoses and advanced disease stages, lead to high morbidity and mortality for mother and foetus.^2,3

Due to the lack of centralised registries for pa-CRC, a consumer-initiated data collection process was undertaken via social media and online patient platforms to highlight the need for further research into pa-CRC. Participants consented to anonymised data collection and utilisation.

Data was available for 28 cases diagnosed 2017–2023. Median age 35 years. Delayed/mis-diagnosis was highly prevalent with only 35% of the cases (10/28) diagnosed within 3 months of presenting symptoms. Majority were diagnosed at advanced stage with stage 3 at 32% (9/28), and stage 4 at 54% (15/28). BRAF and/or KRAS prevalence was higher than anticipated at 60% (9/15 mCRC cases). Metastatic distribution, 20% – M1a, 40% – M1b and 13% – M1c (26% unknown). About 71% of the cancers were left sided. 39% of the cases were diagnosed during pregnancy with 32% diagnosed after delivery. About 60% of the metastatic cases received multi-modality treatment. Of the 15 metastatic patients, three patients are deceased with survival durations of 3.5, 48 and 70 months.

There is a growing need to comprehensively collect data on pa-CRC in relation to incidence, interventions and outcomes. Our findings highlight the critical issue of delayed diagnosis, particularly relevant in pregnancy where symptom overlap occurs. Given the rising incidence of yo-CRC, increased awareness of concurrent CRC in pregnancy is essential. Onco-foetal immune tolerance may accelerate cancer growth during pregnancy, explaining the higher prevalence of advanced disease.⁴ Implementing ctDNA testing during prenatal blood tests offers an opportunity for early detection.^5,6

References:

1. Walters B, Midwinter I, Chew-Graham CA, et al. Pregnancy-associated cancer: a systematic review and meta-analysis. Mayo Clin Proc Innov Qual Outcomes. 2024;8(2):188-199. doi: 10.1016/j.mayocpiqo.2024.02.002. PMID: 38524280; PMCID: PMC10957385.

2. Lee SF, Burge M, Eastgate M. Metastatic colorectal cancer during pregnancy: a tertiary center experience and review of the literature. Obstet Med. 2019;12(1):38-41. doi: 10.1177/1753495X18755958. Epub 2018 Mar 19. PMID: 30891091; PMCID: PMC6416694.

3. Safi N, Li Z, Anazodo A, et al. Pregnancy associated cancer, timing of birth and clinical decision making – a NSW data linkage study. BMC Pregnancy Childbirth. 2023;23(1):105. doi: 10.1186/s12884-023-05359-1. PMID: 36759774; PMCID: PMC9909861

4. Yu J, Yan Y, Li S, et al. Progestogen-driven B7-H4 contributes to onco-fetal immune tolerance. Cell. 2024:S0092-8674(24)00652-4. doi: 10.1016/j.cell.2024.06.012. Epub ahead of print. PMID: 38968937.

5. Dow E, Freimund A, Smith K, et al. Cancer diagnoses following abnormal noninvasive prenatal testing: a case series, literature review, and proposed management model. JCO Precis Oncol. 2021;5:1001-1012. doi: 10.1200/PO.20.00429. PMID: 34994626.

6. IDENTIFY study (ClinicalTrials.gov identifier: NCT04049604)

287 | Health system interactions among regional, rural, and remote cancer carers in Australia: Preliminary results from a national survey

Stephanie P. Cowdery¹, Patricia M. Livingston¹, Anna Ugalde¹, Anna Peeters², Eva Yuen¹, Hannah Jongebloed¹, Bodil Rasmussen¹, Nikki McCaffrey³, Sangeetha Thomas¹, Andrew Lyall⁴, Tamara Pearce⁴, Drew Aras⁵, John Hall⁶, Nora Refahi⁷, Vicki White⁸

¹Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation Faculty of Heath, Deakin University, Burwood, VIC, Australia

²Institute of Health Translation, Faculty of Health, Deakin University, Burwood, VIC, Australia

³Health Economics. Institute for Health Transformation, School of Health and Social Development. Faculty of Health, Deakin University, Burwood, VIC, Australia

⁴Carers Victoria, Melbourne, VIC, Australia

⁵Western Alliance, Melbourne, VIC, Australia

⁶Thorne Harbour Health, Melbourne, VIC, Australia

⁷Carer Advisor, Melbourne, VIC, Australia

⁸School of Psychology, Faculty of Health, Deakin University, Burwood, VIC, Australia

Aims: Adequate care during a cancer diagnosis is vital for patient and caregiver health. Over 50% of caregivers report unmet needs within 6–8 months of a care recipient's cancer diagnosis, with 40% persisting up to 5 years.¹ This study explores challenges in health system interactions faced by cancer caregivers in regional, rural, and remote Australia.

Methods: Data were collected via a cross-sectional online survey. Participants were Australian residents aged 18+ years or older, who had cared for someone with cancer in the past 5 years (the person living with cancer was 15+ at diagnosis). The study aims to recruit 200 non-metropolitan carers by the end of the recruitment period. Carers self-reported their own, and the care recipient's, demographics and clinical details. To assess experiences with health professionals and the health system, respondents rated their agreement with various statements on a 5-point Likert scale, ranging from strongly disagree to strongly agree.

Results: A total of 299 participants (n = 147 regional/rural/remote) completed the survey. Most carers were women (95%) caring for someone with bowel (11%), lymphoma (10%), breast (10%) lung (10%) or prostate cancer (9%). Following adjustment for age, gender, education, employment, and carer status, carers from regional/rural/remote areas were more likely to agree that ‘Healthcare providers have helped [them] understand supports and services available for the person [they] care for’ (AOR 2.1, 95% CI 1.3–3.6, p = 0.005) and that ‘[they] always understand the needs of the person [they] care for’ (AOR 1.9, 95% CI 1.1–3.2, p = 0.008). They were significantly less likely to agree that ‘I spend quite a lot of time actively managing my own health’ (AOR 0.45, 95% CI 0.25–0.82, p = 0.009).

Conclusions: Regional, rural, and remote cancer caregivers reported understanding care needs and available supports for their care recipient, but often neglect their own health, underscoring the need for targeted interventions.

Reference:

1. Lambert S, Hulbert-Williams N, Belzile E, Ciampi A, Girgis A. Beyond using composite measures to analyze the effect of unmet supportive care needs on caregivers’ anxiety and depression. Psychooncology. 2018;27(6):1572-1579.

289 | How do cancer clinical trials include people from diverse genders and sexual orientations?

Haryana M. Dhillon¹, Kerryn Drysdale², Anthony K.J. Smith², Kylie Valentine², Joanne M. Shaw¹, Kirsty Galpin¹, Scott Walsberger³, Karen Price³, Celine Daignault⁴, Anna Hartley⁴, Lindsey Jasicki⁴, Maria Mury⁴, Bridget Haire^5,6

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

²Centre for Social Research in Health, UNSW, Sydney, NSW, Australia

³ACON, Sydney, NSW, Australia

⁴Cancer Institute NSW, NSW Health, St Leonards, NSW, Australia

⁵Kirby Institute, UNSW, Randwick, NSW, Australia

⁶School of Population Health, Faculty of Medicine, UNSW, Randwick, NSW, Australia

Background: Cancer clinical trials collect participant demographic data. Data collection and reporting on gender identity and sexual orientation is limited.

Study Aims: Document what is known about collection of gender and sexuality data in cancer clinical trials, current practices, and perceptions among health care professionals regarding barriers and facilitators to collecting this data.

Methods: Our mixed methods study comprised two components:

Literature review: Relevant peer-reviewed literature was identified by searching Proquest and Pubmed databases with consistent search parameters published between 1 January 2019 and 3 June 2024. Articles were screened, selected, and data extracted in EndNote and Excel by author 2.

Qualitative interviews: Individuals (clinician, researcher, or other professional) with expertise in cancer clinical trials were recruited for structured interview within Australia. Interviews were conducted by two researchers experienced in qualitative research. Data will be analysed thematically, a sample of 5–10 individuals was determined pragmatically based on resources.

Results: We identified six publications for inclusion; all had a connection to sexuality and gender inclusivity in cancer clinical trials. Articles assessed data collection of gender and sexuality (n = 2); knowledge about the proactive inclusion or retrospective recognition of gender and sexuality in cancer research more broadly (n = 2); and indirect relevance to gender and sexuality diverse inclusion in clinical cancer trials (n = 2). Gender and sexuality definitions varied, often collapsed into one demographic group.

Interviews are ongoing and will be completed by 30 September 2024. Preliminary analysis highlights the lack of training with respect to issues specific to LGBTQ+ participants, and no systematic collection of gender identity and sexual orientation data within cancer clinical trials.

Conclusions: Cancer clinical trialists need clear recommendations about how to collect gender identity and sexual orientation data, communication about why it is important, and training on how to incorporate its collection in cancer clinical trials.

291 | Challenges and preparedness for utilising the teletrial model: Qualitative evaluation from a primary site perspective

Joel Ernest¹

¹Peter MacCallum Cancer Centre, Parkville, VIC, Australia

The Australasian Teletrials model is an exciting opportunity for increased access to clinical trial care to a broader group of Australians to enhance their lives through innovative healthcare methods. The adoption of teletrials has been met with challenges, slowing the adoption of this powerful model. A gap existed in the literature for this evaluation to be conducted from a primary site perspective, assuming that teletrial adoption could be driven by experienced primary sites to address this unmet need.

Primary site professionals from a range of roles with teletrial experience were interviewed to obtain information about the roadblocks that they have faced and potential solutions for primary clinical trial sites to be best prepared for the adoption of teletrials in the future. Qualitative analysis resulted in a map of themes for challenges, and preparedness for future application of the model.

Findings include a requirement for health service executives to lead strategic planning to address challenges and progress the model towards sustainable future application. Additionally, a specialised and dedicated workforce may be required through organisational funding to drive model adoption, and resources need to be spent in ensuring education allows for appropriate application of the model.

292 | Transforming access to cancer care: A patient centred, national accommodation directory

Sarah Everitt¹, Katherine Lane¹, Melissa Connor¹, Allyson Osborne¹, Craig Everitt¹

¹MediStays, South Melbourne, VIC, Australia

Aims: Significant logistical and financial barriers are faced by patients travelling from rural and regional communities for cancer care, impacting access to care, outcomes and survival. The primary aim of this audit was to report utilisation of a national accommodation directory for patients requiring accommodation near hospitals. Secondary aims included quantifying accommodation preferences, accommodation rates and financial subsidies.

Methods: Accommodation booking data were extracted from MediStays¹ 2024 database. Bookings were ineligible for inclusion if accommodation was funded by a hospital, health service, insurance agency or charitable organisation. A retrospective audit was undertaken using summary statistics (count and percentage). Endpoints included bookings, location, nights, costs, subsidies, booking method and accommodation preferences.

Results: Of 748 eligible bookings, 496 (66%), 114 (15%) and 78 (10%) were in Victoria, New South Wales and Queensland, respectively. Of these States, the lowest and average nightly rates were $93.45 and $172.20, $114 and $253.44, and $105 and $228.13, respectively. Government nightly subsidies ranged between $45 and $90, $75 and $120 and $70 and $140, respectively. Gap payments varied based on stay length and guest (patient/carer/both). 608 (81%) guests self-booked with an average stay length of 3.2 nights. In contrast Care Navigator assisted outpatient (n114, 14%) and hospital discharge bookings (n = 26, 5%) stayed for 13.9 and 57.4 nights, respectively. Accommodation preferences were hotels 322 (43%) versus self-contained 426 (57%). Of 80 amenities, the top five features were car-parking, walk-in showers, self-contained, onsite management and pet-friendly.

Conclusion: As recommended in a recent Australian white paper2, MediStays’ national accommodation directory provides a dedicated solution for patients and carers. The directory features live streaming of accommodation rates, availability and linkages to financial subsidies. Flexible booking methods include Care Navigators, and a newly released hospital agent portal to further remove barriers faced by patients, thereby enhancing timely and equitable access to life-saving cancer care.

References:

1. MediStays Aust (www.medistays.com.au).

2. Beardmore, R et al. Shining a light: radiotherapy cancer treatment in Australia. 2022; Available at Evohealth: evohealth.com.au/media/shining-a-light.pdf.

293 | Enhancing prostate cancer awareness through targeted community campaigns in a high-risk victorian region

Warren Flatt¹, Bridget Hill², Alan Barlee³, Leigh Matheson¹, Nathalie Davis^1,2

¹BSWRICS, Geelong, VIC, Australia

²South West Healthcare, Warrnambool, VIC, Australia

³Geelong Prostate Support Group, Geelong, VIC, Australia

Background and Aim: Based on Australian Cancer Atlas data, men with prostate cancer from the Victorian Barwon South West (BSW) region face a 50%–60% higher risk of excess mortality and lower-than-average diagnosis rates compared to the rest of Australia. The campaign aimed to increase awareness and educate the BSW community about prostate health and the importance of early detection of prostate cancer via a simple prostate-specific antigen (PSA) screening test.

Methods: The initiative was developed with support from community grants from the Prostate Cancer Foundation of Australia (PCFA) and funding from the Barwon South Western Regional Integrated Cancer Services (BSWRICS). Driven by the experiences of prostate cancer support group members, it addressed myths about routine digital rectal exams, highlighted contributing factors such as family history and age, and prioritised the importance of early detection. A vibrant, multifaceted approach was employed, tailored to address local demographic disparities. This included a geographically targeted social media strategy and a high-impact, community-based educational program to encourage at-risk populations to take action.

Results: The campaign effectively engaged over 37,000 Facebook users, generating more than 8500 interactions. Additionally, over 3500 posters were distributed throughout the region. This comprehensive media campaign coupled with public events, enhanced awareness regarding PSA testing and the critical importance of early prostate cancer detection. Feedback from participants and stakeholders indicated an improved understanding of the contributing factors and symptoms of prostate cancer, as well as increased knowledge about prostate cancer screening methods.

Conclusions: This consumer-led campaign demonstrated that strategic marketing and community engagement are critical in promoting awareness and health education for high-risk populations. The campaign's success may provide a replicable model for future early cancer detection campaigns through community education.

294 | CASEMED cancer patients with pre-existing severe mental disorders development and pilot test of a collaborative care model

Louise Elkjær Fløe¹, Anna Mygind², Poul Videbech^3,4, Jesper Grau Eriksen^1,5, Mette Asbjørn Neergaard^1,5,6

¹Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

²Research Unit for General Practice, Aarhus, Denmark

³Mental Health Center Glostrup, Center for Neuropsychiatric Depression Research, Glostrup, Denmark

⁴Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark

⁵Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

⁶Palliative Care Unit, Aarhus University Hospital, Aarhus, Denmark

Publish consent withheld.

295 | ‘Is it because I'm getting older or is it because I've got cancer?’ – Experiences and perceptions of cancer care for an older adult with cancer

Sharon He^1,2, Heather Shepherd³, Meera Agar⁴, Rebekah Laidsaar-Powell^1,2, Joanne Shaw^1,2

¹School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia

²Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia

³Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

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

Aims: Cancer is more common in older Australians. However, little is known about the cancer care experiences of older people. This study aimed to qualitatively explore the experiences and perceptions of older adults with cancer and caregivers on the impact of aging on treatment decision-making and their cancer care.

Methods: Self-identified older adults with cancer and caregivers completed a brief online survey and participated in a semi-structured telephone interview exploring their perceptions and experiences of treatment decision-making and cancer care. Thematic analysis using a framework approach identified key themes.

Results: Nineteen older adults with cancer and eight caregivers participated. Patient participants had a mean age of 74 years (range 66–90 years), most were diagnosed with blood (n = 9) or breast (n = 8) cancer, and had a mean time of 6 years since initial diagnosis. Majority of caregivers were female (n = 7), providing care for their spouse/partner (n = 5), with a mean age of 63 years (range 44–73 years). Thematic analysis identified three themes: (1) Intersectionality between cancer and aging: patient's views on the impact of age and fitness in treatment decisions, and relationship between receiving a cancer diagnosis and referral to age-related (non-cancer) support, (2) Factors influencing treatment acceptance: trust in clinician and participants’ valuing survival and length of remaining life not just quality of life when making treatment decisions, and (3) Role of the caregiver, including their capacity to provide care.

Conclusion: This study provides insight into the impact of age on cancer care for older adults and questions the underlying assumptions we have when considering who an ‘older’ adult is. This study also highlights the importance of support for caregivers, especially for older caregivers.

296 | The nationally harmonised teletrial supervision plan

Nadine Herren¹, Vincent Pang¹, William Evans², Annaleise Liefting³

¹WA Country Health Service, Perth, WA, Australia

²TrialHub, Alfred Health, Melbourne, VIC, Australia

³Australian Teletrial Program, Brisbane, QLD, Australia

Background: The Teletrial Supervision Plan is a critical document which defines the allocation of clinical trial activities to the satellite site and method of supervision by the Principal Investigator. The national harmonisation of this key document was identified by stakeholders as a high priority in 2023.

Objective: To develop a nationally harmonised Teletrial Supervision Plan that is easy to use.

Methods: A comprehensive review of existing supervision plan templates was conducted by the Australian Teletrial Program Editorial Group. The MoSCoW prioritisation technique was employed to systematically identify essential topics to achieve consensus on required details and wording. Qualitative data was collected from Systems Usability Scale Survey's and written feedback from clinical trial stakeholders for thematic analysis.

Results: A total of 22 responses were collected with highest user representation reported as clinical trial coordinator role (n = 9, 40.91%), Public Hospital location (n = 18, 81.82%) and new users (0-3 Teletrials) (n = 13, 59.09%).

Utility statements such as ‘I found the various components in the Teletrial Supervision Plan were well integrated’ received largely positive responses (Agree: 50.0%; Strongly Agree: 22.7%).Theme categorised feedback suggested greater comparative efficiency, clarity and flexibility with the addition of user interface elements as indicated by responses such as the revised ‘version made it clear where responsibilities were’, and ‘The use of drop-down options and free text boxes ensures flexibility and concise coverage of clinical trial requirements’. One user commented that the Teletrial Supervision Plan could be overwhelming for first-time users.

Conclusion: The Teletrial Supervision Plan has been produced through national collaboration across specialty areas and provides a straightforward and consistent approach enabling teletrials across jurisdictions. The endorsed nationally harmonised Teletrial Supervision Plan has demonstrated user acceptability and usability. Supplementary educational information may be of assistance for first-time users.

297 | On our way to creating a networked clinical trial system: Lessons learnt from the last 2 years

Priyakshi Kalita-de Croft¹, Sabe Sabesan², Craig Underhill³, John Lawson⁴, Kaye Hewson¹

¹Department of Health, Queensland Health, Brisbane, QLD, Australia

²Department of Health, Queensland Regional Clinical Trial Coordinating Centre (RCCC), Queensland Health, Townsville, QLD, Australia

³Border Medical Oncology Research Unit, Border Medical Oncology, Albury, NSW, Australia

⁴NSW Ministry of Health, NSW Health, St Leonards, NSW, Australia

The Australian government's Medical Research Future Fund has bolstered capacity and capability for clinical trials in regional, rural, and remote locations. Through pioneering national initiatives such as the Australian Teletrial Program, the Rural, Regional and Remote Clinical Trial Enabling Program, and ReViTALISE project, significant advancements have been made in health equity and access. These innovative programs aim to bridge the gap between metropolitan and rural healthcare services by leveraging telehealth technologies, allowing decentralized participation in clinical trials. This enables patients in remote areas to access cutting-edge treatments without the need to travel to major urban centers.

In its first 2 years, these initiatives have successfully fostered strong collaboration between metropolitan and regional health services, provided comprehensive training for local healthcare professionals, and deployed reliable infrastructure. While addressing challenges such as technological disparities and regulatory hurdles, these programs continue to evolve through active research and policy refinement. Collectively, they represent a significant step towards achieving equitable healthcare access and offer a scalable model for similar efforts worldwide. This symposium will discuss the successes, challenges, and future directions of these programs.

298 | Collaborative, patient guided approach to a first-in-human study for advanced cancer

Christine Cockburn¹, William Evans², Kylie Shackleton², David Thomas³, Malaka Ameratunga^4,5, Narelle McPhee⁶, Annette Ervin-Haynes⁷, Amel Sadou-Dubourgnoux⁸, Pauline Darcel⁸, Ana Rubio-Jareno⁹, Maryann Rakopoulos¹⁰, Francis Hinds¹⁰

¹Rare Cancers Australia Ltd., Bowral, NSW, Australia

²Alfred TrialHub, Melbourne, VIC, Australia

³Omico, Kensington, NSW, Australia

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

⁵School of Translational Medicine, Monash University, Melbourne, VIC, Australia

⁶Bendigo Health, Bendigo, VIC, Australia

⁷Servier Pharmaceuticals, Boston, MA, USA

⁸Institut de Recherche et Dévelopment Servier, Paris-Saclay, France

⁹Les Laboratories Servier, Madrid, Spain

¹⁰Servier Laboratories, Burnley, Vic, Australia

Aims: Early-phase clinical trials are often the only treatment option for rare and hard-to-treat cancers. Despite this importance, regional and remote patients face barriers to equitable access in studies limited to metropolitan hospitals.

We aim to highlight how a collaboration, guided by lived patient experiences, creates opportunities for innovative trial design and addresses non-metropolitan participation barriers. A sponsor-initiated, first-in-human and molecular-driven study provided the opportunity to apply the patient-centric decentralised trial (DCT) model.

Methods: At study conception, factors limiting regional trial participation were identified between patient advocacy groups and an international sponsor. The collaboration was expanded to Australian metropolitan and regional health services, and research institutions to formulate the final study design. Adaptation of the Teletrial model was chosen due to its risk mitigation approach. The regulatory-approved DCT model required considerable flexibility to conventional study processes and protocol design.

Results: The final DCT model supported seamless movement of study care between metropolitan primary and satellite sites for in-person visits. A primary site was activated to receive regional patients for the first treatment cycles. The satellite site underwent usual regulatory approval and contract negotiations before being placed on hold for all study activities until an eligible participant is identified.

Patient barriers addressed through the collaboration included continuity of trusted care with local healthcare providers, safety concerns, travel burdens and access to informative genomic screening.

Additional benefits: broad screening to help recruitment, rapid activation of new satellite sites, and regional early-phase trial access for sites with limited capacity.

Conclusions: This unique collaboration, unified by a patient-centric vision, is an example of a successful, innovative approach to a first-in-human study. By increasing access to early phase trials closer to home, benefits are achieved for the sponsor, primary and satellite sites, and the regional community.

299 | Blind spots in the hospital: an absence of CALD data

Marlies Iserlohe¹, Meng Tuck Mok^2,3, Vijaya Joshi², Umbreen Hafeez^1,3,4,5

¹Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Germany

²VCCC Alliance, Melbourne, Australia

³University of Melbourne, Melbourne, Australia

⁴Latrobe University, Bundoora, Australia

⁵North Eastern Melbourne Integrated Cancer Services, Heidelberg, Germany

Aim: This project examines what CALD data is collected from patients, how it is collected, and by whom, within Cancer Services at a major tertiary hospital in Victoria. The project investigates any challenges to obtaining complete and accurate data reflective of the CALD population and seeks to assess the relevance of the Australian Bureau of Statistics ‘core’ and ‘standard’ variables to CALD communities.

Methods: A mixed-method approach consisting of: (1) audit of electronic medical records of all outpatients (n = 7243) to assess the frequency of missing CALD data; (2) review of existing organisational policies related to CALD data collection; (3) staff survey to identify gaps in resources, knowledge and training relating to CALD data collection methods; and (4) focus groups with CALD communities prevalent in the Austin catchment area (Mandarin, Arabic, Greek), recruited using snowball sampling. The sessions were transcribed, and thematically analysed.

Results: Patients from non-main English speaking countries or with a preferred language other than English were twice as likely to have one or more indeterminate/missing answer in their electronic medical record (p ≤ 0.05). Administrative staff receive no training in CALD data collection. Variables such as ‘year of arrival in Australia’, ‘ethnicity’, and ‘culture’, whilst not included in the ABS Minimum Standards, were selected by communities as important aspects of CALD identify that should be captured by health service data.

Conclusion: This case study of CALD data collection can be replicated at other hospitals and health care settings. Better resources and training for staff could improve level of completeness of patient data. Data collections should consider the inclusion of ABS non-core variables, especially ‘ethnicity’, ‘culture’, ‘year of arrival in Australia’, to better capture types of diversity beyond language and country of birth. Findings can inform service delivery planning to create a more inclusive and consistent CALD data collection framework.

300 | Reducing the burden on rural cancer patients and their families travelling for treatment: A forecast social return on investment analysis of the MEAL project

Elizabeth (Lizzy) Johnston^1,2,3, Susannah Ayre^1,2, Xanthia Bourdaniotis^1,4, Megan Oster¹, Belinda Goodwin^1,5,6

¹Cancer Council Queensland, Fortitude Valley, QLD, Australia

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

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

⁴School of Psychology, University of Queensland, St Lucia, QLD, Australia

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

⁶School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

Aims: Travelling for treatment imposes a financial burden on rural cancer patients and their families, coupled with the inconvenience and social costs of being away from home. To reduce this burden, dietitians and researchers at Cancer Council Queensland (CCQ) initiated the MEAL project (Making it Easy to Access a meal on arrival at the Lodge).

Methods: Over an 8-week period, guests staying at CCQ's Brisbane accommodation lodge were invited to complete a survey on meal acquisition behaviours and costs for their first meal at the lodge, and anticipated benefits if they were to receive a free, healthy meal on arrival. Survey data were used to conduct a forecast social return on investment analysis for providing lodge guests with a free, healthy meal on arrival.

Results: Of 344 guests during the 8-week period, 178 (52%) completed the survey. Twenty-three percent brought their first meal from home, 14% during transit, and 62% after arriving at the lodge. For the latter two groups, most guests purchased their meal from a cafe (34%), grocery store (25%), or fast food chain (17%). On average, meals cost AUD$15.00 (range AUD$1.50–$50.00) and travel or delivery cost AUD$10 (range AUD$3.00–$50.00) per person. Guests reported spending 60 min (range 5–180 min) preparing and/or acquiring their meal. If a free, healthy meal was provided on arrival, 88% perceived time saved as beneficial, 80% a free meal, 75% no travel or delivery costs, and 75% a healthier or higher protein meal. For every dollar invested in the MEAL project, an estimated AUD$3.00 of social value will be generated for guests.

Conclusions: Through the time and costs saved, and provision of a higher quality meal, the MEAL project offers a practical solution for reducing the burden on rural cancer patients and families travelling for treatment, with a positive social return on investment.

301 | An international comparison of the eligibility and reach of lung cancer screening: Implications for Australia's national lung cancer screening program

Hannah Jongebloed¹, Victoria White², Trish Livingston^1,3, Lan Gao⁴, Vivienne Milch⁵, Anna Ugalde¹

¹Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia

²School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia

³Faculty of Health, Deakin University, Geelong, VIC, Australia

⁴Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia

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

Aims: As Australia moves towards establishment of a National Lung Cancer Screening Program in 2025, understanding optimal eligibility criteria is warranted. Comparing the eligibility criteria and reach of the national and regional programs that currently exist internationally can provide insights into optimal criteria for Australia's program. This study aimed to compare the eligibility criteria for a lung cancer screening program between countries and model the reach of each program.

Methods: Targeted searches were undertaken to identify countries that had implemented or are implementing a national or regional lung cancer screening program. For each jurisdiction, relevant program guidelines, position statements and policy documents were identified, and audits undertaken. Data were extracted on target groups, models of screening, access pathways, costs to participate, priority groups, evaluation and changes to the program since inception. For modelling eligibility, data were sourced at the jurisdiction level on population size, age range, and smoking statistics.

Results: Eight countries (73%) utilised pack years to measure smoking intensity, with four countries, including Australia, adopting 30 pack years as an eligibility requirement. The remaining programs utilised risk prediction models to determine eligibility. For most programs (n = 7; 64%), entry to the program needs support or facilitation from a primary healthcare professional. Australia's program includes strategies to promote a culturally safe program for Aboriginal and Torres Strait Islander peoples.

Conclusions: Australia's lung cancer screening program has a higher pack years requirement and narrower age range than many other international screening programs. Entry to the Australian program will be facilitated by General Practitioners and there is a need to consider the management of at-risk groups who are not currently eligible to be screened. Expanding eligibility criteria for Australia's program in future years could further reduce lung cancer deaths.

302 | Impact of age on time to chemotherapy initiation in breast cancer patients: A comparative analysis of <50 vs. >50 years old

Sachin Joshi^1,2,3, Bhavini Shah¹, Mahesh Iddawela^1,2,3, Sharnali Barua³

¹Latrobe Regional Hospital, Traralgon, VIC, Australia

²Medical Oncology, The Alfred Hopspital, Prahran, VIC, Australia

³Medicine, Monash University, Traralgon, VIC, Australia

Aim: This study investigates the time from diagnosis to chemotherapy initiation in breast cancer patients, comparing those under 50 years old to those over 50. The goal is to identify treatment delays and assess the influence of age on the timeliness of chemotherapy.

Methodology: Data from the statewide cancer indicator platform (SCIP) was analysed, focusing on the interval between diagnosis and chemotherapy initiation, along with multidisciplinary presentation. The study included Gippsland residents diagnosed with breast cancer in 2023 who received care within the region's health services.

Results: A total of 133 patients met the inclusion criteria, divided into two age groups: under 50 and over 50. The median age was 45 years in the younger cohort and 68 years in the older cohort. The younger group accessed health services more quickly, with a median time to multidisciplinary meeting of 27.5 days compared to 35 days for the older group. The median time to chemotherapy initiation was 21 days for patients under 50, while it was significantly longer for those over 50, at 40 days.

Conclusion: The study reveals substantial delays in multidisciplinary care and chemotherapy initiation for older breast cancer patients in Gippsland. These findings underscore the need for targeted interventions to address age-related disparities in cancer treatment

References:

1. Huttunen, T., et al. Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction. BJS Open. 2022;6(4).

2. Zhan, Q.-H., et al. Survival and time to initiation of adjuvant chemotherapy among breast cancer patients: a systematic review and meta-analysis. Oncotarget. 2017;9(2).

303 | Enhancing health equity for all: The Australian teletrial program

Priyakshi Kalita-de Croft¹, Kaye Hewson¹, Sabe Sabesan²

¹Department of Health, Queensland Health, Brisbane, QLD, Australia

²Department of Health, Queensland Regional Clinical Trial Coordinating Centre (RCCC), Queensland Health, Townsville, QLD, Australia

Patients in regional, rural, and remote (RRR) Australia face significant barriers to accessing advanced healthcare due to vast geographical distances and cultural differences. The Australian Teletrial Program (ATP) has been working to bridge this gap by facilitating access to clinical trials under the supervision of experienced primary trial sites located in larger, well-established centers. This discussion explores the experiences, triumphs, and challenges over the past 2 years. Our Regional Clinical Trial Coordinating Centres have been established across all six jurisdictional partners, deploying mobile clinical trial staff to support the workforce at RRR sites, ensuring seamless operation and integration of clinical trials in these areas.

One notable triumph was our invitation to speak at the ‘Equitable Access to Diagnose and Treat Individuals with Rare and Less Common Cancers, Including Neuroendocrine Cancer’ Senate Committee Enquiry. The Senators said ATP is the ‘solution to a problem we have been looking for.’ To date, ATP has conducted 44 teletrials, trained over 4000 individuals in clinical trial methodology, and enrolled 581 RRR participants.

Despite challenges related to regulatory and governance issues, the ATP has made substantial progress. The program has demonstrated that with the right support and infrastructure, it is possible to bring cutting-edge clinical trials to patients in RRR areas, significantly improving health equity and access to advanced healthcare.

304 | What services are available for culturally and linguistically diverse (CALD) patients in the survivorship setting? An Australian study

Lawrence Kasherman^1,2,3, Isaac Addo⁴, Sim Yee (Cindy) Tan^1,2, Ash Malalasekera^1,2, Joanne Shaw⁵, Janette Vardy^1,2

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

²Sydney Cancer Survivorship Centre, Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia

³Department of Medical Oncology, Illawarra Cancer Care Centre, Wollongong, NSW, Australia

⁴General Practice Clinical School, University of Sydney, Sydney, NSW, Australia

⁵Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, NSW, Australia

Aims: People of culturally and linguistically diverse (CALD) backgrounds face disparities in cancer care. This interview-based, qualitative scoping study aimed to explore healthcare professionals’ identification of existing CALD-specific cancer survivorship (CS) resources and supports in Australian oncology centres.

Methods: Oncology professionals were interviewed using a study-specific structured questionnaire exploring demographics, available resources and referral patterns, followed by semi-structured questions exploring factors influencing CALD CS care. Purposive sampling was used to ensure representation across states and remoteness areas, and sample size was guided by data saturation. Contextual survey data were analysed with descriptive statistics, and interviews were recorded and transcribed for thematic analysis.

Results: Twenty-two interviews from 15 institutions across six states were conducted from May to August 2023. Over 25 different CALD groups were identified across all the centres as their top 3–5 CALD populations, and six (40%) centres reported seeing >25% CALD patients. Six (40%) centres reported having dedicated CS services dichotomised into clinic-based or needs-based services. ten (67%) centres reported having CALD-specific resources/supports for oncology patients, and only three (20%) had CS-specific services. Four underlying themes of particular relevance to CALD CS care were identified: patient-clinician interface, with particular regard to the impact of intersectionality in the setting of survivorship and CALD populations; in-language resources and staff with a focus on cultural relevance; structural and logistical considerations with an emphasis on interpreter services, workflow management and models of care; and education and collaboration between healthcare professionals and survivors, carers and community leaders to maximise service building and awareness.

Conclusions: Cancer survivors from CALD backgrounds face unique challenges in receiving optimal care, with limited availability of CALD-specific resources and services in Australian cancer centres. Future works to address these unmet needs should utilise a focused, tailored and collaborative approach to optimise cultural relevance and service engagement.

305 | The Australian cancer plan: Improving equitable access to optimal care

Dorothy Keefe^1,2, Raylene Cox², Claire Howlett², Cindy Toms², John Logus², Kathryn Perkiss², David Meredyth², Kylie Wake², Manaf Al-Momani²

¹School of Medicine, University of Adelaide, Adelaide, SA, Australia

²Cancer Australia, Strawberry Hills, Sydney, NSW, Australia

Introduction: Australia has some of the best cancer outcomes in the world, however receiving optimal cancer care often depends on your background and where you live.

Aim: Enhancing health systems and networks to deliver optimal cancer care will help address disparities in outcomes experienced by Australians.

Methods: The Australian cancer plan sets the priorities for reform in cancer care for the next decade and beyond. Cancer Australia is leading initiatives to achieve equity in access to optimal care.

Results: The establishment of the Australian Comprehensive Cancer Network (ACCN) will support connectivity and sharing of expertise between Comprehensive Cancer Centres and other cancer and health services, ensuring patients have access to optimal care.

Optimal Care Pathways (OCPs) set the benchmark for quality cancer care, outlining consistent, safe, high quality, and evidence-based care. The National OCP Framework will support the standardisation and embedding of optimal care.

Delivering optimal cancer care and enabling a high performing cancer control system needs to be built on access, use and sharing of reliable and comprehensive data across all care settings, both public and private. This is critical to informing continuous improvement of cancer care and identifying policy and research priorities across the cancer control continuum.

In partnership with Cancer Council Australia and the Australian Institute of Health and Welfare, Cancer Australia is leading the development of a National Cancer Data Framework and a minimum dataset to improve the accessibility, consistency and comprehensiveness of cancer data. Having better data regarding optimal care delivery will drive service improvement locally and regionally across Australia. Harnessing the collaboration of the ACCN will drive data driven improvements to cancer care.

Conclusion: This will guide uptake and evaluation of OCPs using the ACCN to embed the utilisation of quality indicators to drive service improvements, consistent with the National Data Framework principles.

306 | Predictors of employment outcomes in cancer survivors: A systematic scoping review

Emma Kemp¹, Anna Ugalde², Skye Marshall², Lisa Grech^3,4, Hannah Jongebloed², Imogen Ramsey⁵, Carolyn Taylor⁶, Deborah Kirk⁷, Georgia Halkett⁸, Cherith Semple⁹, Nicolas Hart^5,10, Darren Haywood¹⁰, Bogda Koczwara^1,11

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

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

³School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia

⁴Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

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

⁶Global Focus on Cancer, New York, USA

⁷School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia

⁸Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia

⁹Ulster University, Jordanstown, UK

¹⁰Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney, Sydney, NSW, Australia

¹¹Department of Medical Oncology, Flinders Medical Centre, Bedford Park, South Australia, Australia

Aims: Maintaining and returning to employment are common challenges for cancer survivors and impact psychosocial and financial outcomes. This study aimed to summarise recent research examining predictors of employment outcomes in cancer survivors.

Methods: Systematic scoping review methodology was used to identify primary research papers that quantitatively examined prediction of any employment outcome in adult cancer survivors, from 2014 to March 2024. Data were extracted on population, setting, predictors, and employment outcomes.

Results: 245 primary research papers were included. They most frequently examined employment outcomes in heterogeneous (n = 77; 31.4%), and breast (n = 75; 30.6%) cancer survivors. Study designs and sample sizes ranged from small cross-sectional surveys (minimum n = 25) to national registry-based studies (maximum n = 136,342). Variables examined as potential predictors related to disease (e.g., cancer type, stage), treatment (e.g., treatment type), sociodemographic (e.g., marital/partnered status), psychosocial (e.g., anxiety, social support), physical health (e.g., physical comorbidities, health behaviours), employment (e.g., role type, job security) and employer characteristics (e.g., workplace social support, employer-based health insurance). The most frequently examined outcomes included return to work (n = 87; 35.5%) and employment status/participation (n = 61; 24.9%). Studies less frequently examined work ability (n = 22; 9.0%), unemployment/job loss (n = 19; 7.8%), cessation/resignation/early retirement (n = 16; 6.5%), work-related disability (n = 15; 6.1%), sickness absence (n = 14; 5.7%), work sustainability (n = 6; 2.5%), working hours (n = 6; 2.5%), and work productivity (n = 5; 2%). Studies were predominantly conducted in Europe (n = 115; 46.9%) or North America (n = 54; 23%). The vast majority were conducted in high-income economies (n = 228; 93%), with minimal representation of lower middle-income (n = 2; 0.8%) or low-income economies (n = 0). Few focused on populations at risk of disadvantage (e.g., low income, rural, insecure work).

Conclusions: Numerous studies examine predictors of employment after cancer. However, populations in low-to-middle income economies and/or experiencing disadvantaged circumstances are under-represented. Outcomes such as work sustainability and productivity remain understudied. Future research should prioritise addressing these gaps.

307 | Enabling access to clinical trials for regional patients with cancer, an operational perspective from The Kinghorn Cancer Centre, St Vincent's Hospital

Robert Kent¹, Aaron O'Grady¹, Chloe Martin¹, Rasha Cosman^1,2,3, Jordan Cohen¹, Jia (Jenny) Liu^1,2,3, Anthony Joshua^1,2,3

¹St Vincent's Hospital, Darlinghurst, Darlinghurst, NSW, Australia

²Garvan Institute of Medical Research, Darlinghurst, NSW

³St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia

Background: The Kinghorn Cancer centre (TKCC) is in a unique position where a high proportion of regional/rural patients are referred to seek treatment options through participation in early phase clinical trials.¹ Historic regional clinical referral pathways, in place for over 15 years has maintained close regional/rural collaboration with hospitals who do not have the infrastructure or capacity to run early phase trials. In order to support their participation, it has been necessary to adapt the trial processes to enable access and decrease the burden on the patients and families through a Decentralised Clinical trials (DCT) approach.

Methods: We reviewed the operational approaches utilised to support regional/rural patients partaking in clinical trials at our site.

Findings: In 2023, TKCC recruited over 120 patients into trials who live >200 km from the centre. Technological adaptations including electronic consenting (e-consenting) via video telehealth, electronic source documentation and remote monitoring were the most utilised strategies deployed in the post-COVID19 pandemic era to maintain engagement and recruitment of regional/rural patients to clinical trials at TKCC. Furthermore, TKCC established national vendors for the collection of health data and management and utilised vendor agreements. Communication with sponsors to allow for local assessments, vitals/ECGs and local bloods/imaging in order to reduce travel and time toxicity were met with universally favourable responses. Delivery of investigational product to allow treatment at home was permitted for stable patients during lockdown. Sponsor reimbursement for travel and accommodation to partake on early phase trials was also helpful however less financial supports were available for investigator-led clinical trials.

Conclusions: Access to research treatment can be achieved for patients living in remote locations through technology, planning and operational logistics partners. Further adaptions are required to ensure central blood management, source documentation, safety and protocol compliance is maintained while supporting regional/rural patients with trial participation.

Reference:

1. Aggarwal N., et al. 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. 2022;18:33-51. https://doi.org/10.1111/ajco.13856.

308 | How does social isolation and socioeconomic status affect cancer trial participation? Results from PEARLER, prospective dataset of patients entering early phase trials in NSW

Kevin Lin¹, Udit Nindra¹, Christina Teng², Joe Wei^2,3, Adam Cooper¹, Kate Wilkinson¹, Aflah Roohullah¹, Charlotte Lemech^2,3, Wei Chua¹, Abhijit PAL¹

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

²Scientia Clinical Research, Randwick, NSW, Australia

³Prince of Wales Hospital, Randwick, NSW, Australia

Background/Aims: Many barriers can affect patient enrolment in early phase clinical trials (EPCTs) and understanding them is essential for achieving equitable access and improving generalisability of trial findings. Recently, more attention has been paid to cancer outcome disparities that arise from social isolation and socio-economic inequality. By analysing prospectively captured data during clinical trial recruitment in NSW, we examine whether living alone and linguistic diversity – factors which could underpin social isolation – in addition to economic disadvantage influences EPCT participation.

Methods: All participants enrolling into EPCTs across two major clinical trials units in NSW were recruited. Participants undertook a baseline demographic survey at commencement of their EPCT. Details regarding EPCT, participant background including basic demographics, living situation and location of primary residence were included. Currently, 84 patients have been prospectively recruited.

Results: Of the 84 recruited patients, the median age was 64 years (IQR: 55–71), forty (48.0%) were male, eighteen (21.0%) self-identified as culturally diverse and seventeen (20%) as linguistically diverse. Only six participants (7.0%) nominated that they were living alone as compared to with family and amongst them, none identified as linguistically diverse. Additionally, 27 (32%) patients resided in the lowest SES quintile.

Conclusion: Our findings suggest that living alone and linguistic diversity may discourage EPCT enrolment. Furthermore, this dataset aligns with previous research demonstrating how social isolation and limited English proficiency reduces healthcare participation – these intersecting vulnerabilities could coalesce and portend poor outcomes. Considering the demographic trend towards increasing single-person households, prospective reporting of such disparities underscore the need for centres to account for limited social supports when ensuring equitable trial recruitment. Interestingly, a disproportionate representation of patients from the lowest SES quintile in this cohort may belie an inability to self-fund advanced therapies although further characterisation of the impact of economic disadvantage is required.

310 | Empowering diversity: Mobile app improves accessibility and training for multilingual radiation therapy patients in breath-hold techniques

Rory Hartley¹, Toby Lowe¹, Alexander Podreka¹, Maiko Crispin¹, John Atyeo¹, Susan Carroll¹, Gillian Lamoury¹, Marita Morgia¹, Brian Porter¹

¹Radiation Oncology, Northern Sydney Cancer Centre, Sydney, NSW, Australia

Introduction: The Deep Inspiration Breath Hold (DIBH) technique is a leading method in radiotherapy for breast cancer treatment due to its efficacy in reducing radiation exposure to critical organs like the heart, LAD, and lungs. At the Northern Sydney Cancer Centre (NSCC), DIBH has become the standard protocol for breast cancer treatment, with notable challenges. Analysis between January 2021 and August 2022 revealed a 20% failure rate among 355 patients. While half of these failures were attributed to pre-existing co-morbidities, the remaining patients, notably those regarded culturally and linguistically diverse (CALD), faced language-related barriers, with the six most common languages at NSCC being Korean, Japanese, Cantonese, Mandarin, Vietnamese, and Arabic.

Methods: An initiative was launched to develop a mobile application to enhance training and accessibility to breath-hold techniques for patients. The application offers patient education in the six languages spoken at the centre, focusing on gated radiotherapy. Recognising the significant proportion of patients (91%) desiring more education before their CT simulation, the app provides early access to familiarise themselves with breath-hold exercises before their scan. Secondly, the application offers pre-recorded verbal instructions for Radiation Therapists in each language, ensuring the safe and effective breath holds during treatment sessions.

Results: The development of the application concluded in March 2024, and its integration into clinical workflow commenced. Initial data indicates a notable improvement in patient-reported confidence in their breath-holding technique before CT scans, alongside an increase in access for CALD patients to the service.

Conclusion: The introduction of a mobile application to address language barriers and improve patient education in breath-hold techniques represents a promising approach in enhancing the effectiveness and accessibility of DIBH in breast cancer radiation therapy. Ongoing evaluation will be crucial to further refine the application and ensure its continued effectiveness in addressing the needs of diverse patient populations.

References:

1. Sixel KE, Aznar MC, Ung YC. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys. 2001;49:199-204.

2. Lai J, Hu S, Luo Y, et al. Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer. Breast Cancer. 2020;27:299-307.

3. Latty D, Stuart KE, Wang W, Ahern V. Review of deep inspiration breath-hold techniques for the treatment of breast cancer. J Med Radiat Sci. 2015;62:74-81.

311 | Achieving equitable access to optimal cancer outcomes for people with disability

Clare N. Lynex¹, Kate Whittaker¹, Drew Meehan¹, Megan Varlow¹

¹Cancer Council Australia, Sydney, NSW, Australia

Aims: Adopting a social model of disability, Cancer Council developed the Disability and Cancer Care policy to address the inequities in access to cancer screening, diagnostic tests and treatment often experienced by people with disability that lead to poorer cancer outcomes and experiences.

Methods: A literature review and consultation with individuals and organisations with expertise in the disability and cancer sector were conducted to understand the factors that influence the experiences and outcomes of cancer for people living with disability. Further policy analysis and evidence reviews were undertaken to shape policy priorities. Policy priorities were refined following further expert consultation, including external peer review.

Results: Four overarching priority areas emerged: (1) improve the collection and reporting of data on disability and cancer; (2) investigate the existing experiences of people with disability and cancer in Australia; (3) develop an Optimal Care Pathway for people with disability to support mainstream health services to be accessible and action adjustments required to ensure optimal cancer care; (4) understand the support needs of people with disability to ensure continuity of care during cancer screening and care to maintain independence and wellbeing.

Conclusions: Through collaboration across all levels of government, social services, health departments, non-government organisations and service providers, cancer services can be more accessible and inclusive, supporting continuity of care and ensuring that disability is not a barrier to optimal care.

312 | VICS optimal care summits protocol – Describing our methods for determining unwarranted variations in cancer care

Ashley Macleod¹, Norah Finn², Tommy Wong², Ella Stuart², Spiridoula Galetakis², Helena Rodi³

¹North Eastern Melbourne Integrated Cancer Services (NEMICS), Victorian Integrated Cancer Services, Melbourne, VIC, Australia

²Department of Health, Victoria, Australia

³VICS Optimal Care Summits, Victoria, Australia

Background: Variations in cancer care and outcomes that cannot be explained by differences in patient illness or patient preferences are referred to as unwarranted variations. Identifying and addressing unwarranted variations, their causes, and improvement priorities is an important part of ensuring the effectiveness, efficiency, and quality of cancer services. However, there is no defined approach to identifying cancer related unwarranted variations in the literature. In Australia, the Victorian Integrated Cancer Services (VICS) Optimal Care Summits program is responsible for working with cancer service providers, consumers, and other cancer organisations to identify unwarranted variations, causes, and improvement priorities.

Aim: To describe the established VICS Optimal Care Summits evidence-based protocol for identifying unwarranted variations in cancer care, the causes, and prioritising service improvement activities to address these.

Methods: Data and information from a rapid systematic review of published literature and environmental scan of policy and reports related to tumour-specific Victorian cancer care will describe the historical state of cancer care, priorities, and outcomes of cancer care in Victoria. Results from statistical analyses of a cancer linked dataset, audit of health records, and surveys completed by consumers and clinicians with experience of tumour-specific cancer care generate a detailed list of unwarranted variations for prioritisation. A 3-round Delphi process involving relevant clinicians and consumers will be used to prioritise unwarranted variations for Summit workshopping activities. Information from the Summit will be used to identify local and statewide improvement priorities and action plan.

Conclusion: Formalising the mixed-methods approach used by the VICS Optimal Care Summits in a protocol will help ensure unwarranted variations are clearly defined, data collection and analyses are transparent and reproducible, and priority setting for cancer service activities are supported by evidence.

313 | Examining the experience of culturally and linguistically diverse cancer patients in Victoria using the 2023 cancer patient experience survey data

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

¹Austin Health, Heidelberg, VIC, Australia

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

Aim: To examine the cancer patient experience survey (CPES) responses for culturally and linguistically diverse (CALD) Victorians who were admitted for cancer care in 2022 across Victorian public hospitals.

Methods: CALD respondents were identified as those who indicated they spoke any language(s) other than English at home. A mixed-method analysis of CPES data was conducted comprising quantitative analysis of multiple-choice responses and qualitative analysis of free-text responses. Themes from thematic analysis of free-text responses were categorised by their relevance to the seven principles of care described in the Optimal Care Pathways (OCPs) that underpin optimal cancer care in Australia.

Results: Of the 3630 people who participated in the CPES, 247 (7%) were classified as a CALD patient. Most (98%) respondents rated their overall care as either ‘very good’ or ‘good’. Over half (62%) of the respondents said they did not need an interpreter during appointments. Of those that did, only 56% recalled having an interpreter available at most or all appointments. Many quantitative findings were similar to the Victorian statewide average, suggesting positive progress is being made towards equitable cancer care in Victoria. Additional opportunities for cancer experience and care improvement were also identified. These included improving access to information and support for patients and their family/friends, better access to financial support information, and better communication of contact details for concerns post-discharge. Free-text responses mostly related to the OCP principles of communication, patient-centred care, and care coordination, emphasising concerns related to limited interpreter services and bilingual staff, a lack of communication with patients, a lack of empathy from staff, and long waiting times.

Conclusions: The findings highlight the need for improved communication, information sharing, and supportive care for CALD patients and family/friends including better access to interpreter services or bilingual staff, compassionate health professionals, and better system coordination.

314 | An evaluation of the cancer experience of aboriginal and Torres Strait Islander cancer patients in Victoria using the 2023 cancer patient experience survey data

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

¹Austin Health, Heidelberg, VIC, Australia

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

Aim: To examine cancer patient experience survey (CPES) responses for aboriginal and Torres Strait Islander Victorians who were admitted for cancer care in 2022 across Victorian public hospitals.

Methods: Respondents who identified as aboriginal, Torres Strait Islander, or both aboriginal and Torres Strait Islander were included in this analysis. A mixed-methods approach was used to conduct a quantitative analysis of multiple-choice responses and qualitative analysis of free-text responses of the CPES. Themes from the thematic analysis of free-text responses were organised based on their relevance to the seven principles of the optimal care pathways (OCPs) that underpin optimal cancer care in Australia.

Results: Despite prioritisation of Indigenous cancer experiences in the current Victorian Cancer Plan, only 25 (<1%) of the 3630 people who participated in the CPES identified as Aboriginal and/or Torres Strait Islander. As such, all findings should be considered with caution. All (100%) respondents rated their overall care as either ‘very good’ or ‘good’. Many quantitative findings aligned with statewide averages; however, several improvement opportunities were apparent. These opportunities include improving timeliness of treatment, better information provision to patients regarding possible treatment side-effects, radiotherapy preparation, and follow-up care, better pain management during surgical admissions, and improved access to referrals and information about supportive care and other services. Themes in free-text responses focused on two OCP principles: communication, and safe and quality care. Experiences articulated by Indigenous respondents in free-text responses emphasised a lack of communication, lack of privacy, and a lack of resources and staff.

Conclusions: These results highlight the need for improved communication, information provision, and increased focus on ensuring indigenous patient safety and dignity across the cancer journey. The low proportion of respondents who identified as Aboriginal and/or Torres Strait Islander highlights the need for more community engagement to ensure insightful cancer patient experience data.

315 | A regulatory perspective on the setup of decentralised clinical trials

Chloe Martin¹, Jia (Jenny) Liu^1,2,3, Rasha Cosman^1,2,3, Jordan Cohen¹, Anthony Joshua^1,2,3, Robert Kent¹

¹St Vincent's Hospital, Darlinghurst, Darlinghurst, NSW, Australia

²Garvan Institute of Medical Research, Darlinghurst, NSW, Australia

³St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia

Decentralised clinical trials (DCTs) represent a paradigm shift in clinical research,¹ offering flexibility and accessibility while ensuring regulatory compliance. The COVID-19 pandemic accelerated the rapid uptake of digital processes to maintain clinical trial activity, validating long-standing advocacy efforts. The Kinghorn Cancer Centre trials unit at St Vincent's Hospital Sydney adapted to function as a decentralised clinical trial (DCT) unit, and in the process, enhanced our ability to offer more equity in access to trials for rural, regional and remote populations. We will highlight the operational setup, challenges and successes associated with this experience.

DCT set up

To establish remote capabilities, we leverage digital technologies for trial start-up, document management, electronic signatures, remote consent processes and virtual visits. Collaboration with Health Research Ethics Committees (HRECs) and Regulatory and Governance Offices (RGOs) ensures compliance across regulatory landscapes.

DCT challenges

Challenges emerge from differing regulatory requirements and interpretations between states, local health districts and ethical and regulatory committees. Clear communication and alignment among all parties, including sponsors, contract research organisations, and regulatory bodies are crucial to navigate these complexities and support novel trial methodologies.

DCT successes

Despite challenges, our transition yielded substantial successes. Since 2019, the clinical trial unit not only sustained operations but also expanded significantly. We secured HREC approval as the lead site for 104 new trials, predominantly phase 1, and RGO approval for 249 new trials. Conducting regulatory processes entirely remotely facilitated efficient trial management and continued knowledge sharing.

Summary:

While DCTs pose regulatory challenges, their implementation with digital innovations significantly enhances trial efficiency and patient-centricity. Continuous collaboration among stakeholders and ongoing dialogue with regulatory authorities are essential to overcome barriers and promote decentralised approaches in clinical research effectively. This experience underscores the transformative potential of DCTs in advancing equitable access to innovative therapies across diverse patient populations.

Reference:

1. Underhill C, Freeman J, Dixon J, et al. Decentralized clinical trials as a new paradigm of trial delivery to improve equity of access. JAMA Oncol. 2024;10(4):526-530.

316 | Delays to post-operative radiation therapy for patients with head and neck squamous cell carcinoma: A mixed-methods analysis of health worker perspectives

Ravi Marwah^1,2, Justin Smith^2,3, Daniel Goonetilleke⁴, Madhavi Chilkuri²

¹Department of Radiation Oncology, Townsville University Hospital, Townsville, QLD, Australia

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

³Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia

⁴Dalby Hospital, Dalby, QLD, Australia

Background: Post-operative radiation therapy (PORT) delays are associated with reduced survival and higher recurrence rates in patients with head and neck squamous cell carcinoma (HNSCC).^1–3 Our previous work evaluating PORT delays at Townsville University Hospital (TUH) reported greater delays in Indigenous patients and patients receiving surgery at external facilities.⁴ The objective of this study was to explore health worker perspectives on barriers and solutions to timely PORT.

Methods: This paper incorporated an explanatory sequential mixed methods design. Healthcare workers involved in the care of patients with HNSCC at TUH were invited to participate. Participants completed an online survey and subsequently underwent semi-structured focus group interviews. Key themes were explored using thematic analysis, with recruitment for interviews terminated at thematic saturation.

Results: Nineteen healthcare workers participated in the surveys. The three factors most attributed to PORT delays were regional/rural location (89%), surgery at an external facility (84%), and Indigenous status (74%). Ten healthcare workers subsequently participated in interviews. Three themes regarding solutions to PORT delays were identified; overcoming cultural barriers, addressing care fragmentation, and improving care coordination. Strategies proposed to overcome cultural barriers included instituting cultural immersion programs, promoting earlier Indigenous Liaison Officer engagement, supporting family involvement, and developing culturally appropriate resources for patients and families. Solutions suggested to address care fragmentation included streamlining referral systems, utilising electronic reminders, avoiding double-handling of care, and increasing local service provision. Strategies proposed to improve care coordination included flagging patients early, timely organisation of transport & accommodation, and employing head and neck-specific cancer care coordinators.

Conclusion: This study highlights barriers and solutions to timely PORT in an Australian regional centre with a large Indigenous population. Strategies aimed at both the patient and systems level and formed in partnership with Indigenous peoples must be instituted to address delays and reduce systemic health disparities.

References:

1. Harris JP, Chen MM, Orosco RK, Sirjani D, Divi V, Hara W. Association of survival with shorter time to radiation therapy after surgery for US patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2018;144:349-359.

2. Ang KK, Trotti A, Brown BW et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;51:571-578.

3. Franco R, Marta GN. Timing factors as prognostic variables in patients with head and neck squamous cell carcinoma treated with adjuvant radiotherapy: a literature review. Rev Assoc Med Bras. 2020;66:380-384.

4. Marwah R, Goonetilleke D, Smith J, Chilkuri M. Evaluating delays in patients treated with post-operative radiation therapy for head and neck squamous cell carcinoma. J Med Imaging Radiat Oncol. 2022;66(6):840-846.

317 | Enhancing the wellbeing of refugees living with advanced life-limiting illness, their families and carers in high-income resettlement countries: a qualitative systematic review

Heidi Merrington¹, Abela Mahimbo¹, Michelle DiGiacomo¹, Meera R. Agar¹, Sally Nathan², Andrew Hayen¹, Anita E. Heywood², Angela Dawson¹

¹University of Technology, Sydney, NSW, Australia

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

Aim: Little is known about what enhances well-being for refugees with advanced life-limiting illness and their families after resettlement in high-income countries. We conducted a systematic review to identify factors that enhanced well-being for refugees and their families during end-of-life care and bereavement.

Methods: We systematically reviewed empirical studies published between 2003 and 2024. We searched the following electronic databases: MEDLINE, EMBASE, CINAHL, PSYCHInfo, Web of Science Core Collection, Scopus, Proquest Dissertations and Theses Global, and Overton. We applied a strength-based asset framework to data extraction and synthesis and conducted a directed content analysis.

Results: Ten of the 1006 studies identified were included in the review: two qualitative and one quantitative; and seven case studies. Six of the included studies involved either single case participants with cancer, their spouse or other family and friends. We identified 17 assets that enhanced well-being: resilience, religion, spirituality, identity and belonging, community connections, health and death literacy, acculturation, family and community support, social capital, community structures, access to funeral information, access to services, palliative care approaches and workforce capacity. Many assets were linked with resilience. The role of identity and community in strengthening resilience and social support was highlighted, through connections within cultural and religious networks. Social capital, as a resource inherent to social networks, could facilitate access to acceptable end-of-life care provided by community members, and the development of meaningful mourning and funeral rituals for refugees in resettlement. Palliative care approaches need to respond to refugees’ experiences of loss and grief and enhance communication with families about treatment goals, prognosis and spiritual care.

Conclusions: Further research, co-designed with diverse groups of people from refugee backgrounds, is needed to inform palliative care service approaches, develop effective interventions and explore in a more nuanced manner the role of social capital in promoting and protecting wellbeing.

318 | Digital health technology use among people diagnosed with cancer aged 55 years and over: Findings from the 45 and up study

David Mizrahi¹, David E. Goldsbury¹, Peter Sarich¹, Anne E. Cust¹, Nehmat Houssami¹, Emmanuel Stamatakis², Karen Canfell¹, Marianne F. Weber¹, Julia Steinberg¹

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

²The University of Sydney, Sydney, NSW, Australia

Introduction: Digital technologies, including activity trackers and smartphone applications, are modern tools to support health behaviours in cancer care. This study described utilisation patterns and correlates of digital technology use among middle-aged and older Australian cancer survivors.

Methods: We used data from 45 and Up Study (267,357 participants aged ≥45 years recruited in 2005–2009), specifically the 2019 follow-up questionnaire (Wave 3) that included technology use questions. We included participants diagnosed with cancer after baseline, identified using linked data from the NSW Cancer Registry. We considered three technology use categories: broad digital technology (e.g., computer, tablet), small portable devices (e.g., smartphone, fitness tracker), and digital health applications (e.g., steps, nutrition, medication). We used multivariable logistic regression to examine associations between participants’ self-reported sociodemographic, health and behavioural characteristics with digital technology use.

Results: 31,946 participants completed the 2019 follow-up questionnaire (47% response rate), which included 5948 cancer survivors (median age = 73 years [Q1–Q3: 67–79]. Of cancer survivors (29% prostate, 18% breast, 16% melanoma, 37% other), 83% reported broad digital technology use, 28% active use of small portable devices, and 25% digital health application use. For all three categories, digital technology use was significantly associated with younger age, urban living, holding private health insurance, higher income and education, greater physical function, higher physical activity, non-smokers, and lower red and processed meat intake. There were no differences in digital technology use by years since cancer diagnosis, marital status, body mass index, fruit and vegetable intake, and co-morbidities including osteoporosis, cardiovascular disease, and depression/anxiety.

Conclusions: Digital technology use was relatively high in this cohort of middle-aged and older Australian cancer survivors, varying significantly by sociodemographic, health and behavioural characteristics. These findings may inform the feasibility and planning of targeted interventions that leverage digital technologies with the goal of improving the health of cancer survivors.

319 | Provision of cancer systems by cancer services for culturally and linguistically diverse patients

Meng Tuck Mok^1,2, Umbreen Hafeez^2,3,4, Alesha A. Thai⁵, Nicole Rankin², Nicola Creagh², Marlies Iserlohe³, Vijaya Joshi¹, Jennifer Philip^2,6, Kalinda Griffiths⁷

¹VCCC Alliance, Melbourne, Victoria, Australia

²The University of Melbourne, Parkville, Victoria, Australia

³Austin Health, Heidelberg, Victoria, Australia

⁴North Eastern Melbourne Cancer Services, Heidelberg, Victoria, Australia

⁵Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁶St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia

⁷College of Medicine and Public Health, Flinders University, Darwin, NT, Australia

Aims: Culturally and linguistically diverse (CALD) patients receive suboptimal healthcare with poorer outcomes. Missed identification, unclear information and/or lacking knowledge about services negatively impacts cancer care for CALD communities. VCCC Alliance aims to address these by supporting projects across community, primary and tertiary settings.

Methods:

Project 1:

A round table with varied stakeholders led to a mixed methods approach to understand how CALD patients are identified at one Victorian health service. An audit of major patient data systems assessed the collection of Australian Bureau of Statistics-recommended data variables to identify CALD patients.

Project 2:

A multi-site qualitative programme aims to identify barriers and facilitators by cancer CALD patients and carers to access symptom support services. Using experience-based co-design methodology in partnership with patients, carers, health care professionals and community representatives, this study aims to design, implement, and evaluate interventions for equitable and culturally safe symptom support services.

Project 3:

To augment implementation of the National Lung Cancer Screening Program (NLCSP), bi-cultural workers, peer workers and interpreters working in primary and community organisations providing care and support to CALD communities were interviewed to assess needs and tailored solutions.

Results: Auditing data captured by hospital data collection systems revealed insights for improving identification of CALD patients.

Qualitative analyses of focus groups from CALD patients and carers at two Victorian tertiary centres are examining barriers and facilitators accessing symptom support services. The co-design phase, ADVANCE-ACCESS, commences in 2025.

To encourage CALD communities’ participation in the NLCSP, multi-pronged approaches including education sessions, multilingual resources and materials, peer worker support, and general practitioners are essential in identifying eligible CALD participants.

Conclusion: CALD communities should lead the development and implementation of strategies for accurate data capture and improved support services, enhancing engagement, better equity to access healthcare, including lung cancer screening, thereby improving health outcomes.

320 | Understanding the provision of palliative care for people experiencing homelessness in Victoria

Jumaien Momen¹, Jennifer Philip¹, Cara Platts¹

¹Palliative Nexus, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia

Background: Despite various governmental strategies, the number of people experiencing homelessness (PEH) in Victoria has risen over the last decade. PEH face greater rates of physical and mental ill-health generally, but also experience poorer outcomes at the end-of-life, including greater rates of malignancy. Effective palliative and end-of-life care is vital to ensure their last days are as pain-free and dignified as possible. Despite inequity in end-of-life outcomes, there exists little clarity on existing approaches and resources available for this growing vulnerable cohort.

Aim and Objectives: This project aims to understand the provision of palliative care for PEH in Victoria. This will be fulfilled by two objectives: (1) To identify and map existing resources and strategies for palliative care provision to PEH; and (2) To explore providers’ perspectives and perceived barriers or facilitators to providing palliative care to PEH.

Methodology: This mixed-methods survey study of palliative care providers involves two parts: (1) Quantitative data collection: provider demographics, capacities, policies and training; (2) Qualitative data collection: perceived barriers, facilitators, and other perspectives around palliative care provision for PEH. Data will be collected until thematic saturation is achieved. Quantitative data will be descriptively analysed and represented through heat maps, graphs or tables. Qualitative data will be thematically analysed as per Braun and Clarke's method to allow description of key themes from providers around delivering quality care.

Results: Preliminary results suggest that palliative care access for PEH is multifactorial. Barriers include weak relationships between PEH and healthcare, lack of address and limited funding. However, some facilitators to access include multidisciplinary team strengths and flexible policies.

Significance: This will be the first work to map existing services and resources available for palliative care provision to PEH in Victoria. It will establish baseline information to advise future service development to improve palliative care access for this growing cohort.

321 | The feasibility of nurse-led telephone follow-up for breast cancer patients in India: Perspectives from healthcare professionals

Ambili A.N. Nair¹, Ravani R.D. Duggan¹

¹Curtin University, Perth, WA, Australia

Aim: This study aimed to explore the need and feasibility of nurse-led telephone follow-up care (NLTFC) from the perspective of healthcare professionals (HCPs) in breast cancer care in India.

Method: A mixed-methods formative evaluation was conducted at a major healthcare facility in Punjab State, India. Participants, comprising HCPs from Oncology and General Surgery, were recruited using purposive sampling. For quantitative data, the target was 210 participants, however, only 112 were recruited due to increased workloads for HCPs post-COVID-19. For the qualitative component, 27 participants were recruited based on data saturation. Surveys and interviews were analysed using descriptive statistics and thematic analysis, respectively.

Results: Three overarching themes emerged, supported by quantitative data: (1) Living with breast cancer; (2) Follow-up care; (3) Nurse-led model of care. Physical and psychological consequences of diagnosis and treatment, along with societal factors such as cancer stigma and women's position in a patriarchal society, were perceived to influence women's experiences and quality of life (QoL). Shared care models within NLTFC were identified as a promising approach to improve follow-up care and address existing gaps. HCPs noted gaps in psychosocial care (65% of nurses and 69% of doctors) and concerns about treatment adherence (23% of nurses and 12% of doctors). Of note, HCPs expressed strong support for NLTFC, with 98% of nurses and 94% of doctors showing support for its implementation. While they voiced concern about the potential for important information being missed, the majority believed NLTFC would enhance patient confidence in communicating their needs to HCPs (97% of nurses and 88% of doctors). HCPs recommended specialised training and structured support for nurses.

Conclusions: Despite identified challenges, HCPs strongly support NLTFC, confirming its feasibility with proper training and support. The findings can inform the broader implementation of nurse-led models of care across Punjab and other Indian states.

322 | Achieving equity for all cancer patients – A prospective study of representation of LGBTQIA+ patients on early phase cancer clinical trials: results from a PEARLER sub-study

Rebecca H. Nguyen¹, Udit Nindra¹, Christina Teng², Joe Wei^2,3, Andrew Killen², Adam Cooper¹, Kate Wilkinson¹, Aflah Roohullah¹, Charlotte Lemech^2,3, Wei Chua¹, Abhijit P.A.L.¹

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

²Scientia Clinical Research, Randwick, NSW, Australia

³Prince of Wales Hospital, Randwick, NSW, Australia

Background: Patients identifying as LGBTQIA+ experience discrimination and structural stigma, leading to poorer engagement with healthcare and inequities with treatment, and as a consequence, poorer outcomes across the cancer care continuum.¹ Three to four percent of Australians identify as non-heterosexual,^2–3 and 1% as gender-diverse.⁴ Despite this, there has been no research on representation of LGBTQIA+ patients in cancer early phase clinical trials (EP-CTs). We sought to prospectively examine the representation of LGBTQIA+ patients successfully recruited to EP-CTs.

Methods: All participants enrolling into EP-CTs across two major clinical trials units in NSW were recruited. Participants undertook a baseline demographic survey at commencement of their EP-CT. Details regarding EP-CT, participant background including demographics, cultural status, familial status, and gender and sexual identities were included. Currently, 84 patients have been prospectively recruited.

Results: The median age of patients was 64 years (IQR 55–71). Fifty-four patients (64%) were ECOG PS 0, and thirty patients (36%) were ECOG PS 1. Patients were located across NSW, including South-Western Sydney (n = 13), South-Eastern Sydney (n = 11), Southern NSW (n = 6), Hunter/New England (n = 6), and Illawarra/Shoalhaven (n = 6) Local Health Districts. Eighteen patients (21%) were born outside Australia; the most common countries of birth apart from Australia were England (n = 4), China (n = 4), and Iraq (n = 2).

Forty patients identified as male, forty-four as female, and no patients self-identified as gender-diverse. All patients (n = 84) self-identified their sexual orientation as heterosexual; no patients listed their sexual orientation as ‘same-sex‘ or ‘other’.

Conclusions: EP-CTs offer a valuable opportunity in cancer management, yet our study found that no LGBTQIA+ patients were successfully recruited. This may be a product of poor access for LGBTQIA+ patients to EP-CTs, or lack of willingness to identify as LGBTQIA+. Further work, including active demonstration of inclusivity, needs to be done to ensure equitable recruitment of cancer patients including LGBTQIA+ patients into EP-CTs.

References:

1. Leone AG, Trapani D, Schabath MB, et al. Cancer in transgender and gender-diverse persons: a review. JAMA Oncol 2023;9(4):556-563.

2. Australian Bureau of Statistics. General social survey: summary results, Australia, ABS Website. 2020; accessed 21 July 2024.

3. Wilson T, Temple J, Lyons A, & Shalley F. What is the size of Australia's sexual minority population? BMC Res. Notes. 2020;13:1-6.

4. Higgins DJ, Lawrence D, Haslam DM, et al. Prevalence of diverse genders and sexualities in Australia and associations with five forms of child maltreatment and multi-type maltreatment. Child Maltreat. 2024;10775595231226331.

323 | Experiences of Arabic speaking patients in Australian cancer care and views on enablers of clinical trial participation – Findings from a consumer workshop in NSW

Michael Camit¹, Rayan Saleh Moussa², Christine Jeyechandran¹, Tim Luckett², Charbel Bejjani^1,2, Ben Smith^2,3, Slavica Kochovska², Nadine El-Kabbout², Arwa Abousamra², Amin Gadalla¹, Iman Zakhary¹, Azhar Matti¹, Randa Kattan⁴, Verena Wu³, Wei Chua¹, Karen Wong¹, Shalini Subramaniam¹, Bernadette Brady¹, Gemma McErlean⁵, Balwinder Sidhu¹, Matthew Jennings¹, Sandra Avery¹, Deme Karikios⁶, Frances Boyle⁷, Wafa Trad¹, Weng Ng¹, Stephen Della-Fiorentina¹, Martin Hong¹, Udit Nindra¹, Meera Agar², Abhijit Pal¹

¹Sydney South West Local Health District, 2153, NSW, Australia

²UTS Cancer Symptoms Trials Group, UTS CST, Sydney, Australia

³University of Sydney, Sydney, Australia

⁴Arab Council of Australia, Sydney, Australia

⁵University of Wollongong, Wollongong, Australia

⁶Nepean Hospital, Sydney, Australia

⁷Mater Hospital, University of Sydney, Sydney, Australia

Aims and Background: Improving representation of culturally and racially marginalised communities in cancer clinical trials is a key goal as it enables individuals to gain access to the benefits of scientific research and for communities to have representative trials. We aimed to understand the enablers and barriers to trial participation for Arabic speaking patients in Australia, and to gain consumer input into a trial navigator solution.

Methods: A four-hour workshop for Arabic-speaking adults and/or carers with direct experience of cancer was conducted in March 2024. Participants (n = 25) were recruited through social media and cancer stakeholder networks, with three breakout groups facilitated in Arabic and one in English. Sessions were recorded, transcribed and translated. Thematic analysis was conducted independently by two research team members.

Results: The first part of the workshop on the experience of the cancer journey revealed two key themes: (1) contrast between the Australian and the home country healthcare systems (non-disclosure of diagnosis, paternalism); and (2) distrust of Australian healthcare due to frequent miscommunications and misunderstandings (often due to poor interpreter access). The second part on research revealed three themes: (1) difficulties engaging in research due to trust and communication challenges during their cancer journey; (2) suspicion of clinical research, influenced by poor experiences in their home country; and (3) definite interest in trial navigator but strong focus on cultural safety.

Conclusion: This is the first data on perspectives of Arabic-speaking Australians on cancer clinical research participation. We documented multiple instances of culturally unsafe cancer care. We hypothesise that under-representation in clinical research, which requires significant trust, is a downstream consequence of accumulated mistrust in standard cancer care. We are continuing our work on designing a culturally safe trial navigator to improve research participation and building community trust in Australian cancer care.

325 | Understanding unwarranted variations in care for Victorian oesophagogastric cancer patients: a comparative analysis between 2012–2016 and 2017–2021

Frances Graham¹, Wanyu Chu², Paul Cashin³, David Liu⁴, Norah Finn², Helena Rodi¹, Tommy Wong², Nicklause Baje¹, Linda Nolte⁵

¹Victorian Integrated Cancer Services, Heidelberg, VIC, Australia

²Department of Health, Melbourne, VIC, Australia

³Monash Health, Melbourne, VIC, Australia

⁴Austin Health, Heidelberg, VIC, Australia

⁵North Eastern Melbourne Integrated Cancer Services, Heidelberg, VIC, Australia

Background: The Victorian Integrated Cancer Services (VICS) Optimal Care Summits (OCS) program engages clinicians and consumers in identifying unwarranted variations in cancer care and outcomes against optimal care pathways (OCP).

Aim: To determine Victorian unwarranted variations in oesophagogastric (OG) cancer compared to the OCP, across two periods.

Methods: This is a population-level retrospective analysis of Victorians with a primary diagnosis of OG cancer between 2012 and 2021, identified via the Victorian Cancer Registry dataset. Data were drawn from multiple linked administrative datasets including the Victorian Admitted Episodes Dataset, Radiotherapy Minimum Dataset, Emergency Minimum Dataset, and Victorian Death Index. These datasets provided information on demographics, tumour and treatment characteristics, and measures aligned with OCP standard.

Results: Improved outcomes between the time periods included reduced mortality 1 year post gastrectomy. The proportion of oesophageal cancer patients that received chemotherapy locally increased from 79% to 81%. Patient multidisciplinary meeting presentation increased from 74% to 86%.

Unwarranted variations included time from diagnosis to any treatment within 6 weeks for non-metastatic gastric cancer (64%, 2012–2016 and 60%, 2017–2021) and for oesophageal cancer patients (58%, 2012–2016 and 60%, 2017–2021) lower than the OCP standards. One regional ICS demonstrated a statistically different survival compared to the statewide average for gastric cancer in 2017–2021. There was greater variation in survival for gastric cancer for 2017–2021 compared to 2012–2016. A new indicator showed on average, only 58% of OG cancer surgical and/or chemotherapy patients were seen by a dietitian within 3 months of diagnosis between 2017 and 2021.

Conclusions: There are unwarranted variations for OG cancer care in Victoria. Despite some improvements across the two periods, targeted action is required to address these variations including lower survival rates in some ICS.

326 | Identification of unwarranted variations, causes and improvement priorities in Victorian oesophagogastric cancer care: A mixed-methods analysis

Frances Graham¹, Wanyu Chu², Paul Cashin³, David Liu⁴, Norah Finn², Helena Rodi¹, Tommy Wong², Nick Baje¹, Linda Nolte⁵

¹Victorian Integrated Cancer Services, Heidelberg, VIC, Australia

²Department of Health, Melbourne, VIC, Australia

³Monash Health, Melbourne, VIC, Australia

⁴Austin Health, Heidelberg, VIC, Australia

⁵North Eastern Melbourne Integrated Cancer Services, Heidelberg, VIC, Australia

Background: An unwarranted variation in cancer care and/or outcome is a disparity that is not explained by differences in patient illness or preferences. The Victorian Integrated Cancer Services (VICS) Optimal Care Summits program identifies unwarranted variations against the standards and targets determined in the Optimal Care Pathways (OCP). The program explores the causes of unwarranted variations and identifies clinician and consumer informed improvement priorities. Addressing unwarranted variations in cancer care is challenging but critical to promoting health equity.

Aim: To describe the mixed methods, approach and priority unwarranted variations in oesophagogastric cancer (OG) across Victoria.

Qualitative data was subject to thematic analysis and quantitative data was subject to descriptive statistical analysis. Both data was then synthesised.

The summit identified causes and produced 21 suggested improvement high impact/low resource initiatives for prioritisation.

Conclusions: This novel mixed methods approach demonstrates an effective strategy for identification of unwarranted variations, causes and improvement priorities to promote alignment with tumour specific OCPs.

327 | The national landscape of needs-analysis assessment to promote equitable exercise and diet referrals in oncology practice: The NEEDS study

Grace L. Rose^1,2, Kate A. Bolam^1,3, Brenton J. Baguley⁴, Hattie H. Wright¹, Tamara L. Jones⁵, Briana K. Clifford⁶, Mary A. Kennedy⁷, Amy M. Dennett⁸, Tina L. Skinner^1,6, Elizabeth P. Pinkham⁹, Nicolas H. Hart¹⁰, Pamela J. Meredith¹, Bryan A. Chan^11,12

¹School of Health, University of the Sunshine Coast, Sunshine Coast, QLD, Australia

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

³Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

⁴Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia

⁵Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia

⁶School of Health Sciences, University of New South Wales, Sydney, NSW, Australia

⁷School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia

⁸La Trobe University, Melbourne, VIC, Australia

⁹Princess Alexandria Hospital, Brisbane, QLD, Australia

¹⁰INSIGHT Research Institute, University of Technology Sydney, Sydney, NSW, Australia

¹¹Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia

¹²Griffith University, Brisbane, QLD, Australia

Background: The importance of exercise and diet to enhance outcomes of people across the cancer continuum is well known; however, referrals to exercise and diet specialists are infrequent. Exercise and diet referrals are often driven by patients who know to ask, or health professionals who are aware of diet and exercise importance, meaning that patients don't receive equitable opportunity for referral. Assessment-based triage pathways (needs-analysis assessment), to prioritise those likely to benefit most from exercise and diet referrals, could reduce this inequity. However, best practice for needs-assessment and triage is unknown. To learn from current practice within health services, this study explores the landscape of needs-analysis assessments that lead to targeted exercise and diet referrals within Australian oncology practices, and provider recommendations for improvement.

Methods: Oncology medical and allied health professionals actively delivering cancer services within Australian private or public health services will be included (target sample size n = 100). The survey will include questions regarding current health service practices in exercise and diet needs-analysis (e.g., if, when and how assessment is conducted, and using what tools), along with suggested recommendations for improvement (e.g., time, timing). Quantitative responses will be descriptively summarised, with qualitative responses coded and analysed thematically.

Results: Recruitment and data collection is on-going; preliminary results of the survey will be presented.

Conclusions: This study will summarise current exercise and diet needs-analysis practices among Australian oncology services, including the number of services that have an active triage pathway, and what needs-analysis assessments are included in these contexts. By collating this information and provider-informed recommendations for improvement, the final step is to adapt and develop a needs-analysis tool for national utility. Ultimately, this work will enable us to better identify and target people most likely to benefit from exercise and diet referrals and interventions, to enhance service delivery and equity.

328 | Opportunities and future directions to create equitable clinical trial system in Australia

Sabe Sabesan¹, John Lawson², Lisa Zhang³, Wei-Sen Lam⁴, Lewis Campbell⁵, Paul Worley⁶, Rosemary Harrup⁷

¹Department of Health, Queensland Regional Clinical Trial Coordinating Centre (RCCC), Queensland Health, Townsville, QLD, Australia

²NSW Ministry of Health, NSW Health, St Leonards, NSW, Australia

³Northeast Health Wangaratta, Wangaratta, Victoria, Australia

⁴Department of Research and Innovation – WA Regional Clinical Trial Coordinating Centre, Bentley, WA, Australia

⁵Northern Territory Health, Darwin, NT, Australia

⁶Riverland Academy of Clinical Excellence, Adelaide, SA, Australia

⁷Royal Hobart Hospital, Hobart, Tasmania, Australia

The Australian Teletrial Program and the NSW/ACT RRR Clinical Trial Enabling Programs are laying the groundwork for an equitable and networked clinical trial system in Australia. Collaborations with the Victorian Teletrial Collaborative have further facilitated the integration of teletrials for cancer trials in Victoria. These infrastructure and capacity-building initiatives are revolutionising the clinical trial landscape in Australia.

Through collaboration among states and territories, we have the opportunity to create ‘patient-centered’ and ‘workforce-enabling’ uniform satellite site activation processes. These processes will leverage national mutual acceptance of ethics, mutual acceptance of primary site approvals, supervision plan templates, and cluster sub-contracts. Sponsor organizations such as AGITG have already started including ‘teletrial’ as a recruitment method within their protocols. With continued industry and ACTA partnerships, we hope this will become routine practice.

The Commonwealth's One Stop Shop will serve as an enabling platform to harmonize processes across Australia, while the National Clinical Trial Governance Framework will guide health services to incorporate trials as routine practice in service delivery. Additionally, collaboration with national and international clinical peak bodies, including the Clinical Oncology Society of Australia, the American Society of Clinical Oncology, and the European Cancer Organisation, will strengthen our advocacy to influence global sponsors and CROs to adopt the teletrial model as a tangible example of a decentralized clinical trial system globally.

329 | Perspectives of healthcare professionals and researchers on barriers and enablers of cancer clinical trial participation among Arabic-speaking Australians

Rayan Saleh Moussa¹, Abhijit PAL², Michael Camit², Christine Jeyachandran², Tim Luckett¹, Charbel Bejjani², Ben Smith³, Slavica Kochovska⁴, Nadine El-Kabbout¹, Arwa Abousamra¹, Sally Fielding¹, Maria Gonzalez¹, Amin Gadalla², Iman Zakhary², Azhar Matti², Randa Kattan⁵, Verena Wu⁶, Wei Chua², Karen Wong², Shalini Subramaniam², Bernadette Brady², Gemma McErlean⁷, Balwinder Sidhu², Matthew Jennings², Sandra Avery², Deme Karikios⁸, Frances Boyle³, Wafa Trad², Weng Ng², Stephen DellaFiorentina², Martin Hong², Udit Nindra², Meera Agar¹

¹University of Technology Sydney, Ultimo, NSW, Australia

²South Western Sydney Local Health District, Sydney, Australia

³University of Sydney, Sydney, Australia

⁴University of Wollongong, Wollongong, Australia

⁵Arab Council Australia, Sydney, Australia

⁶University of New South Wales, Kensington, NSW, Australia

⁷South Eastern Sydney Local Health District, Sydney, Australia

⁸Nepean Blue Mountains Local Health District, Penrith, UK

Background and Aim: Culturally and linguistically diverse (CALD) Australians experience poorer healthcare access and outcomes. These inequities are compounded by the exclusion and underrepresentation of CALD communities in cancer clinical trials on potentially life-saving treatments. Research has often overlooked systemic and structural inequalities, focusing instead on community-level barriers. This study explored barriers and enablers to cancer clinical trial participation among Arabic-speaking Australians through healthcare professional and researcher perspectives, aiming to provide insights for improving access and inclusion of Arabic-speaking patients in cancer clinical trials and to inform a bilingual trial navigator (BTN) role.

Methods: A qualitative study comprising focus groups with healthcare professionals working with Australian Arabic-speaking adults who have cancer. Participants were recruited via social media and professional networks. Participants were asked about their experiences recruiting Australian Arabic-speaking patients to cancer clinical trials and their input on designing a BTN role. Focus groups were recorded, transcribed and analysed thematically by two researchers.

Results: Fourteen participants were recruited (10 clinicians, two nurses, one clinical trial coordinator and one researcher). Participants highlighted several challenges in recruiting Arabic-speaking patients for cancer clinical trials including consultation time constraints, trial inclusion/exclusion criteria, limited resources (e.g., funding and translated materials), and access to interpreters. Arabic-speaking participants noted difficulties with accurately translating clinical trial terminology. Additionally, there were instances of clinician bias which may have resulted in the exclusion of certain individuals from trials. Participants supported the BTN idea to address some of these challenges and emphasised the importance of distinguishing this role from existing roles (e.g., interpreter and care coordinator), and ensuring seamless integration within the clinical workflow.

Conclusion: Findings underscore significant sponsor, site and clinician-level barriers to recruiting Arabic-speaking patients for cancer clinical trials. Further research and resourcing of strategies like a BTN role may be helpful to enhance access to these trials.

330 | Examining prognostic disparities between regional and metropolitan lung cancer patients: A registry based study

Evangeline Samuel^1,2, Eldho Paul³, Sanuki Tissera¹, Mike Lloyd¹, Craig Underhill⁴, Sagun Parakh⁵, Rob Blum⁶, Phillip Parente⁷, Inger Oleson⁸, Javier Torres⁹, David Langton¹⁰, Thomas John¹¹, Phillip Antippa¹², Matthew conron¹³, James Bartlett¹⁴, Gavin Wright¹³, Wasek Faisal¹⁵, Nik Zeps¹, John Zalcberg¹⁶, Rob Stirling^17,18

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

²Medical Oncology, Latrobe Regional Health, Victoria, Australia

³Monash University, Melbourne, Australia

⁴Albury Wodonga Health, Wondonga, NSW, Australia

⁵Olivia Newton John Cancer Centre, Heidelberg, Victoria, Australia

⁶Bendigo Health, Bendigo, Victoria, Australia

⁷Eastern Health, Melbourne, Victoria, Australia

⁸Barwon Health, Andrew Love Cancer Centre, Geelong, VIC, Australia

⁹Goulburn Valley Health, Shepparton, VIC, Australia

¹⁰Peninsula Health, Melbourne, VIC, Australia

¹¹Department of Oncology, Sir Peter MacCallum, Melbourne, VIC, Australia

¹²Department of Cardiothoracic surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia

¹³St Vincent's Hospital, Melbourne, VIC, Australia

¹⁴Western Health, Melbourne, VIC, Australia

¹⁵Medical Oncology, Grampians Health, Ballarat, VIC, Australia

¹⁶Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia

¹⁷Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia

¹⁸Central Clinical School, Department of Medicine, Nursing and Health sciences, Melbourne, VIC, Australia

Aims: Lung cancer is the 5th most common cancer in Australia and the leading cause of cancer-related death. This study examines whether prognostic factors and survival rates differ between regional and metropolitan lung cancer patients using a population-based registry cohort.

Methods: Patients with non-small cell lung cancer (NSCLC) diagnosed between 2011 and 2023 were identified from the Victorian Lung Cancer Registry (VLCR). Residence at diagnosis was categorized using the Modified Monash Model (MMM) into metropolitan, regional, remote, and rural. Demographic and cancer-specific characteristics were compared between regional and metropolitan areas. The association between residence at diagnosis and overall survival was assessed using Cox proportional hazards regression models.

Results: Of 13,154 NSCLC patients, 4092 (31%) lived in regional and remote areas. Median age was 68–69 years across groups. Regional/remote patients had more current smokers (36% vs. 30%, p < 0.001) and fewer never smokers (7% vs. 15%, p < 0.001) compared to metropolitan patients. No significant differences were observed in gender or comorbidities. Metropolitan patients had fewer cases of stages I and II disease (15% vs. 19%, p < 0.001). All four SEIFA (Socio-Economic indexes for areas) indices (IRSAD, IRSD, IEO, IER) revealed significantly worse socio-economic conditions in regional and rural communities compared to metropolitan areas (e.g., IRSAD: metro 8.0 vs. regional 5.0 vs. rural/remote 3.0, p < 0.001). Multivariate analysis showed no significant association between residence at diagnosis and overall survival after adjusting for age, gender, stage, performance status, smoking, and comorbidities (metropolitan vs. regional HR 0.92, 95% CI 0.85–1.01, p = 0.075; metropolitan vs. rural/remote HR 0.97, 95% CI 0.92–1.02, p = 0.245).

331 | Co-designing for implementation: A patient-focused clinical trials navigation tool

Kate Saw¹, Joseph Elias², Arya Shinde², Natalie Taylor², Ann Dadich³, Jeremy Mo^1,4,5, Kate Macdonald⁶, Mary Lloud⁶, Graham Rossiter⁶, Marissa Crawford⁶, Jo River⁷, Rachel Dear^4,5, Elgene Lim^1,4,5

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

²School of Population Health, UNSW, Sydney, Australia

³School of Business, Western Sydney University, Sydney, Australia

⁴School of Clinical Medicine, UNSW, Sydney, Australia

⁵The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

⁶Lived Experience Researcher, Sydney, Australia

⁷University of Technology Sydney, Sydney, Australia

Aims: Clinical trials participation is critical to advance cancer research and in turn improve patient care, yet patient enrolment remains low. Fragmentation within the clinical trials structural landscape, along with complex information and medical jargon that is difficult for patients and carers to navigate, necessitates that repositories of clinical trials information be better tailored to stakeholder needs in order to optimise patient engagement and outcomes. In order ro enhance equity of access to clinical trials, this study aims to establish the barriers and facilitators for both clinician access to clinical trials opportunities, as well as patient access to clinical trials information.

Methods: Using the double diamond design framework, focus groups and semi-structured interviews were conducted with lived experience participants (n = 7) and healthcare professionals (n = 12). Data was analysed both deductively, informed by the constructs of the consolidated framework for implementation research (CFIR2.0), and inductively, to capture additional findings, beyond the framework.

Results/conclusion: Preliminary findings from seven lived-experience participants and 12 healthcare professionals in phase one of this co-design study highlights a range of challenges with accessing relevant, up-to-date and easily understandable information about clinical trials. These include low awareness of, and literacy in relation to, trials concepts for patients, along with inefficient search processes and trials information dissemination from clinicians’ perspectives. These findings are important because they can inform the development of barrier matched strategies to enhance patient access to clinical trials information. To that end, they will be employed in the co-design of a clinical trials navigation tool, which will provide patients and healthcare professionals with a curated list of clinical trials based on individual patient demographics and cancer characteristics. The tool will use large language models to generate lay-language text, to address diverse health literacy needs and maximise the tools equitable reach.

332 | Equity in action: A strategic approach to financial toxicity in Victoria

Christie Allan¹, Beth Scholes¹, Amy Corbett¹, Danielle Spence¹, Amanda Piper¹

¹Cancer Council Victoria, East Melbourne, VIC, Australia

Background: Cancer Council Victoria is committed to reducing the financial burden of cancer through tailored support and policy influence, underpinned by our Health Equity Framework.

Data from our cancer information and support service shows the cost of cancer significantly impacts some Victorians. In 2023, over 20% of connections to our service were for practical issues, including financial costs.

Research shows younger, socioeconomically disadvantaged, and regional populations face higher financial burden which often outweigh physical, social and emotional impacts of cancer.

Responses to reduce financial toxicity at the state level are limited.

Aims: To create an advocacy roadmap to reduce financial toxicity for people affected by cancer in Victoria.

Methods: A mixed-methods approach, including analysis of evidence and review of eight national and state policies on cancer costs. Structured consultations with multidisciplinary health professionals (n = 13) and community members (n = 7) with diverse gender and geographical representation (three metropolitan, four regional).

Results: Financial burden associated with cancer disproportionally affects Victorians who are socioeconomically disadvantaged with less access to insurance, financial resources or support in times of unexpected stress. Regional populations can experience higher indirect costs associated with travel and time off work.

Advocacy activities guided by the roadmap will target population groups who experience greater financial burden.

Conclusions: Our advocacy roadmap presents a novel strategy to tackle financial toxicity at the state-level, with a focus on improving cancer care equity. It sets out how we will achieve our vision to reduce the financial burden of cancer.

333 | Equitable access to support groups for people with metastatic cancer: Do we have the evidence to support their implementation? And if so, what factors are impacting on their adoption and roll-out across Australia?

Andrea L. Smith^1,2, Frances Boyle³, Michele Daly⁴, Fiona Dinner⁵, Marika Franklin², Melanie Hamilton⁶, Pia Hirsch⁷, Kim Hobbs⁸, Laura Kirsten⁹, Kitty-Jean Laginha², Stephanie Lentern², Sophie Lewis², Zhicheng Li¹⁰, Grace Mackie³, Carolyn Mazariego¹¹, Ros Chao¹², Mary O'Brien¹³, Amanda O'Reilly¹⁴, Jasmine Ekaterina Persson³, Natalie Taylor¹¹, Lisa Tobin¹⁵

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

²University of Sydney, Sydney, NSW, Australia

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

⁴Consumer Advisory Panel, Cancer Institute, Sydney, NSW, Australia

⁵Consumer representative, Melbourne, Victoria, Australia

⁶University of Sydney, Camperdown, NSW, Australia

⁷Advanced Breast Cancer Group, Brisbane, QLD, Australia

⁸Westmead Centre for Gynaecological Cancers, Sydney, NSW, Australia

⁹Nepean Cancer Care Centre, Sydney, NSW, Australia

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

¹¹Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

¹²Support group facilitator, Melbourne, VIC, Australia

¹³Advanced Breast Cancer Group, Brisbane, QLD, Australia

¹⁴Support group facilitator, Sydney, NSW, Australia

¹⁵Breast Cancer Network Australia, Melbourne, VIC, Australia

Aim: To understand the value of metastatic support groups, starting with metastatic breast cancer (MBC), and factors influencing their adoption, implementation and sustainment including system/organisational factors.

Methods: We performed a scoping review of impact and implementation of metastatic support groups. This informed our interviews with people with MBC, male partners, group facilitators and key informants. Data were analysed thematically and discussed by project team, including three consumers. Implementation determinants were identified using consolidated framework for implementation research.

Results: The review (19 studies: eight RCTs; seven qualitative; two cohort; two mixed-methods) identified evidence of effectiveness of metastatic support groups, particularly psychosocial outcomes. Eighty-three participants were interviewed (28 patients; 16 partners; 20 support group facilitators; 19 key informants). Cross-cutting themes included importance of metastatic support groups and professional facilitation given high MBC patient/partner unmet needs and unique survivorship challenges. MBC patient/partner and facilitator data indicated support groups provided much-needed connection to MBC community, safe space for sharing experiential knowledge and having open conversations. Key implementation challenges included suitably skilled group facilitators, access to clinical supervision, and sustainable funding models. Key informant data indicated systemic challenges including lack of national framework to inform standards, model-of-care and delivery of groups. The ‘corporatisation’ of many not-for-profits, the increasingly risk-averse culture, insecure funding streams, and need to demonstrate impact has seen a shift from delivery of face-to-face services such as support groups to mass-reach, online services (e.g. helplines, online forums) which are more easily evaluated and reported as impactful.

Conclusion: There was strong agreement across datasets that metastatic support groups, particularly face-to-face groups, were of value and that they should be led by trained professional facilitators. Equitable access to metastatic support groups will require a national framework/model-of-care and cooperation among stakeholders to utilise their expertise in metastatic cancer, support group leader training, and supportive care delivery.

334 | Comparative analysis of biomarker testing rates and treatment patterns in NSCLC patients: Australia versus EU4+UK

Imogen Smith¹, Clara Brown¹, James Etwell¹, Lawrence Farrell¹, Emma Peffer¹, Euan Wilson¹, Stephen Della-Fiorentina^2,3

¹IQVIA, Australia, NSW, Australia

²School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

³Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia

Aim: Non-small cell lung cancer (NSCLC) has a poor 5-year survival rate, highlighting the need for optimised treatment via molecular testing of predictive biomarkers. This study compares biomarker test rates and results between Australian and EU4+UK patients to address NSCLC disparities.

Methods: We analysed anonymised patient-level data from the cross-sectional online survey conducted by the IQVIA Oncology Dynamics real-world data database. The Australian cohort (n = 515) covered 2022–2024, while the EU4+UK cohort (n = 10,448) included the most recent moving annual total (MAT) to March 2024. We focused BRAF, EGFR, ROS1, ALK and PD-1/PD-L1 testing rates, results, and treatment patterns.

Results: Australia had higher ALK testing rates (88%) than the EU4+UK (82%), with ALK positivity at 5% and 10%, respectively. Most ALK-positive patients received ALK inhibitors (100% vs. 95%). BRAF testing rates were 63% in Australia and 59% in the EU4+UK, with a 1% positivity. In Australia, 86% of BRAF-positive patients received PD-1/PD-L1 inhibitors, while 46% in the EU4+UK received BRAF inhibitors. ROS1 testing rates were higher in Australia (84% vs. 71%), with ROS1 positivity at 2% and 1%, respectively. Most ROS1-positive patients received ROS1 inhibitors (60% vs. 64% respectively). EGFR testing rates were similar in Australia (88%) and the EU4+UK (84%), with an equal 21% positivity rate. Most EGFR-positive patients received EGFR inhibitors (79% vs. 84%). PD-1/PD-L1 testing rates were higher in Australia (91%) compared to the EU4+UK (85%), with positivity rates of 73% and 64%, respectively. Most PD-1/PD-L1-positive patients received PD-1/PD-L1 inhibitors (64% in Australia and 58% in the EU4+UK).

Conclusions: Australia's stricter adherence to testing protocols led to higher mutation rates. Variations in treatment choices, particularly limited use of BRAF inhibitors in Australia, highlight regional differences and access to subsidised therapies. Standardised testing protocols and equitable access to treatments could enhance global NSCLC care, reducing disparities and improving patient outcomes.

335 | Patient navigation to improve ethnic minority cancer care in high income countries: A systematic review

Sandra Sonego¹, Kate McBride^1,2, Catharine Fleming^1,3

¹Translational Health Research Institute, Western Sydney University Sydney, Sydney, NSW, Australia

²School of Medicine, Western Sydney University Sydney, Sydney, NSW, Australia

³School of Science and Health, Western Sydney University Sydney, Sydney, NSW, Australia

Aims: Ethnic minority (EM) populations living in high income countries (HIC) often have poorer cancer outcomes and face additional challenges when accessing cancer care. Patient navigation (PN) is an approach to overcome barriers to care, improve outcomes and reduce cancer disparities. This systematic review aimed to evaluate the impact of PN on improving EM cancer care in HICs and identify key characteristics and components of effective oncology PN programs that had positive effects in these populations.

Methods: Peer-reviewed literature in the English language (published between January 2004 and January 2024) was searched in the following databases: PubMed, Ovid MEDLINE, APA PsycINFO, Web of Science, CINAHL, Cochrane Library and Scopus. We included primary experimental or quasi-experimental studies comparing PN programs to usual care, delivered to adult EM patients with any type of cancer, from abnormal finding to survivorship and palliative care.

Results: Eighteen studies were included in this review, all conducted in the United States. Constituent minority populations were Hispanic (35.6%), Black American (27.7%), Native American (13.9%) and Asian (1.2%), with breast and cervical as the most common cancer types. Most studies (13) focused on diagnostic evaluation outcomes. Of the 18 included studies, 15 reported improvements in cancer care outcomes. We encountered significant heterogeneity in PN program characteristics and inconsistencies in methodology reporting. Some common core components and culture-centred features of effective PN programs were identified.

Conclusion: There is a moderate amount of evidence indicating PN is effective in improving cancer care for ethnic minorities, particularly during the diagnostic evaluation phase. This review has identified important characteristics of successful programs that can help shape future oncology navigation services for ethnic minority communities. Additionally, a reporting standards guideline for the publication of oncology navigation studies is proposed, to enhance the comparability across cancer PN research.

336 | Is patient age associated with treatment approach and survival outcomes in mucosal head and neck squamous cell carcinoma? An Australian observational study

Farhannah Aly^1,2,3, Purnima Sundaresan^4,5, Joseph Descallar^1,2, Lois Holloway^1,2,3,6, Shalini K. Vinod^1,3

¹Southwest Sydney Clinical Campus, University of New South Wales, Sydney, NSW, Australia

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

³Liverpool and Macarthur Cancer Therapy Centres, Southwest Sydney Local Health District, Sydney, NSW, Australia

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

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

⁶Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia

Background: Older patients (≥70 years) with mucosal head and neck squamous cell carcinoma (mHNSCC) present complex management challenges. Due to their underrepresentation in clinical trials, they may receive non-standard treatment based on their performance status, comorbidities and expected treatment toxicity. Investigating treatment patterns and identifying factors associated with outcomes are important in determining optimal treatment approaches.

Aims: To investigate patterns of care and survival outcomes of older versus younger patients with mHNSCC.

Methods: A retrospective review of patients diagnosed with mHNSCC between 2010 and 2018, at six NSW hospitals was conducted. Pretreatment patient and tumour characteristics, treatment approaches (radiotherapy + chemotherapy), plus overall survival (OS) data were collated. Multivariable analysis of factors influencing curative standard-of-care (SOC) treatment allocation and OS was performed.

Results: Of 1553 eligible patients, 432 were ≥70 years. Older patients were significantly less likely to be offered curative treatment (75.7% vs. 91.6%, p < 0.001), chemotherapy (33.0% vs. 67.8%, p < 0.001) or SOC treatment (59.6% vs. 74.0%, p < 0.001). Fewer older patients receiving primary radiotherapy were prescribed ≥66 Gy (83.9% vs. 89.9%, p = 0.004). Unpartnered marital status and ECOG 1+ performance status were associated with lower SOC treatment allocation for younger patients. ECOG 1 performance status was associated with lower SOC treatment allocation for older patients. Older patients receiving curative SOC treatment had lower median OS (78.8 vs. 118.4 months, p < 0.001). Smoking and ECOG status affected OS for both cohorts. SOC affected OS for older patients.

Conclusion: Age was associated with treatment allocation. Older patients were less likely to receive SOC treatment, which influenced OS. Whilst older patients should ideally receive SOC treatment to optimize OS, other factors such as ECOG performance status and social support should be considered, given their OS was still poorer than for younger patients. These patients may specifically benefit from geriatric assessment and shared decision making in geriatric oncology models of care.

338 | Financial toxicity in regional and rural cancer patients: An Australian regional tertiary centre perspective

Jai Thompson^1,2, Georgia Slapp³, Marcus Hu^1,3, Hock Choong Lai^1,3, Sabe Sabesan^1,3, Amy Brown^1,3

¹James Cook University, Townsville, QLD, Australia

²Darling Downs Hospital and Health Service, Toowomba, QLD, Australia

³Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia

Aims: To quantify the rates and magnitude of financial toxicity in cancer patients from a large regional tertiary cancer centre, and explore the impacts.

Methods: Patients presenting between April 2023 and April 2024 were invited to complete a survey including demographics, subjective financial distress questionnaire (SFDQ), and out-of-pocket costs (OOPC). Optional free-text questions allowed for further details of financial impacts, and possible solutions. Analysis of 386 responses is presented. Descriptive statistics summarised quantitative data, and free-text responses through content analysis (n = 214).

Results: The majority of respondents were male (59.6%); prostate (26.2%), breast (22.8%) and head and neck (11.1%) cancer diagnoses most common; with a mean age of 67.5 ± 12.3. 39% were currently receiving treatment. 34.2% travelled ≥100 km for treatment, and 48.2% had some telehealth care. Of those eligible, 72.5% had accessed the patient travel subsidy scheme. 65.5% received all of their care at our centre. 51% received chemotherapy; 71.8% radiation therapy and 52.1% surgery.

31.6% reported income reduction with treatment, and 28.8% changed employment status following cancer diagnosis. 8.3% reported a SFDQ-scored rating of three or above, indicating financial distress, and 23.1% with a rating of 2. Median OOPC of $350 (IQR $0–$2300) was reported.

Impacts reported included further details of income/employment changes of both patient and family members; reduction in discretionary and other spending; added mental impact of managing finances. Suggestions for possible solutions included early information and conversations and regarding finances from healthcare team, expediting support/assistance such as the travel subsidy scheme, improved financial cover for pre-diagnosis tests.

Conclusions: This study supports the growing body of evidence of financial toxicity experienced by patients receiving or following cancer treatment, highlighting inequity challenges faced by rural and remote populations. These results provide a baseline for our regional centre, underscoring areas for future improvement and research, with further analysis planned.

339 | Launch of the co-designed equitable cancer outcomes across rural and remote Australia (ECORRA) project

Anna Ugalde¹, Skye Marshall¹, Serene Yoong², Camille Short³, Anna Chapman¹, Fiona Crawford Williams^4,5, Rebecca Bergin^1,6,7, Anna Wong Shee⁸, Joel Rhee⁹, Deme Karikios^10,11, Nicole Kiss¹², Lucy Leigh^13,14, Lan Gao², Anna Boltong¹⁵, Kate Gunn¹⁶, Hannah Jongebloed¹, Helena Rodi^1,17, Hannah Beks¹⁸, Nicolas H. Hart¹⁹

¹Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, VIC, Australia

²Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, VIC, Australia

³Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences and Melbourne School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC, Australia

⁴McGrath Foundation, Sydney, NSW, Australia

⁵College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia

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

⁷Department of General Practice and Primary Care, and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia

⁸Deakin Rural Health, Deakin University, Australia and Grampians Health, Western Victoria and the Grampians, VIC, Australia

⁹Discipline of General Practice, School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia

¹⁰Sydney Medical School, University of Sydney, Camperdown, NSW, Australia

¹¹Department of Medical Oncology, Nepean Hospital, Kingswood, NSW, Australia

¹²Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Burwood, VIC, Australia

¹³Hunter Medical Research Institute, New Lambton Heights, NSW, Australia

¹⁴School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

¹⁵Monash University, Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash Health, Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, Australia

¹⁶Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia

¹⁷Victorian Integrated Care Services, Heidelberg, VIC, Australia

¹⁸Deakin Rural Health, Deakin University, Warrnambool, VIC, Australia

¹⁹Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney, Sydney, NSW, Australia

Aims: Australians in rural and remote areas may experience delays in cancer diagnosis and treatment commencement of up to 53 days, compared to their metropolitan counterparts, contributing to poorer survival. To reduce this inequity, the equitable cancer outcomes across rural and remote Australia (ECORRA) project was launched in 2024 to co-design and embed an implementation package to support rural and remote cancer services to align with the optimal care pathways (OCPs), as recommended in the Australian Cancer Plan.

Methods: The ECORRA project, funded by the Medical Research Future Fund, uses best practice recommendations to co-design a sustainable and scalable, evidence-informed, implementation package for rural and remote health services. Commencing 2024, Phase 1 uses the theoretical domains framework to guide interviews with professional and consumer stakeholders to identify the key determinants influencing the implementation of the diagnosis- and treatment-related components of the OCPs. Relevant determinants will then be mapped to implementation strategies. Commencing 2025 and drawing upon Phase 1 results and realist reviews, Phase 2 will conduct a series of workshops with diverse and representative stakeholders from rural and remote Australia to co-design and refine an implementation package prototype. From 2026-2029, a pragmatic stepped-wedge cluster randomised trial will embed and evaluate the implementation package in 14 rural and remote cancer care services across South Australia, Victoria, and Queensland.

Results: The ECORRA implementation package is hypothesised to improve adherence to the diagnosis- and treatment-related components of the OCPs in rural and remote cancer services, to be acceptable and feasible, and lead to reduced healthcare costs. Partnerships with stakeholder organisations and representatives have been formalised via the ECORRA Charter and will facilitate nationwide scaling from 2029 onwards.

Conclusions: The ECORRA Project represents a substantial investment and commitment to reduce inequity in cancer diagnosis and treatment services for rural and remote Australians nationally.

341 | The impact of socioeconomic factors on incidence, mortality and morbidity of cardiovascular diseases in First Nations people with cancer: a systematic review

Cassandra Vujovich-Dunn¹, Mihye Jeon¹

¹University of Queensland, Herston, QLD, Australia

Aim: First Nations people with cancer are associated with poor survival and high prevalence of comorbidities. Socioeconomic and racial disparities may exacerbate cardiovascular health in people diagnosed with cancer. This review aims to investigate the association between socioeconomic factors and treatment related cardiovascular disease outcomes in First Nations people with cancer.

Methods: Searches were conducted in OVID Medline, OVID Embase, CINAHL, and SCOPUS. Observational studies were included if focused on First Nation populations, from high income countries (OECD high income category 1), peer-reviewed quantitative observational and experimental studies with a focus on socioeconomic factors. Studies were excluded for paediatric populations, non-cancer populations, reporting on non-First Nation populations, non-English language studies, abstracts, editorials, commentaries, case reports/series, and qualitative studies.

Risk of bias in included studies was assessed using the risk of bias in non-randomized studies-exposures (ROBINS-E) tool.

Results: Review is currently underway. The results will include a synthesis of the pooled extracted data of included studies summarizing the findings based on the overall strength of the evidence and consistency of observed effects.

Implications: A key priority of the newly released Achieving Health Equity in Cancer Care with Aboriginal and Torres Strait Islander Queenslanders is Optimal Cancer Care, which includes engagement of the primary health care sector in supporting Aboriginal and Torres Strait Islanders across the cancer continuum using integrated approach to care, including management and treatment of cardiovascular diseases post cancer diagnosis. Optimal Cancer care also includes supporting Aboriginal and Torres Strait Islander people living well with, through and beyond cancer. Examining the impact between socioeconomic factors and cardiovascular disease in First Nations people will provide important insights on how to improve cancer care and outcomes and guide future priorities and policy for optimal care.

342 | Evaluation of cancer clinical trials resources for culturally and linguistically diverse (CALD) communities

Verena S Wu^1,2, Ben Smith^1,2, Orlando Rincones², Mayra Ouriques³, Sheetal Challam³, Lindsey Jasicki³, Maria Mury³, Tracey O'Brien³

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

²South West Sydney Clinical Campuses, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia

³Cancer Institute NSW, St Leonards, NSW, Australia

Aims: Lack of in-language information is a recognised barrier to clinical trial (CT) access for culturally and linguistically diverse (CALD) patients. Lack of diversity can limit validity of CT findings when applied to real-world settings, contributing to disparities in cancer outcomes in minority populations.

Cancer Institute NSW co-designed in-language resources to increase awareness and knowledge regarding CTs. Resources were translated into the seven most prevalent language groups in NSW.

This qualitative study evaluated the cultural acceptability and appropriateness of the resources, informing quality improvement and dissemination.

Methods: Community members and clinicians were identified via established partnerships, at arm's length from the evaluation team. Semi-structured interviews were conducted by telephone/Zoom between May and September 2022 focusing on the cultural acceptability of information content, appropriateness of resource format, and suggested dissemination methods. Interview transcripts were thematically analysed.

Results: Community members (n = 12) from seven language groups, and clinicians (n = 2) participated. Regarding acceptability, community members perceived key messages as relevant, with potential to strengthen both knowledge and trust in CTs among CALD communities. The information that CTs could lead to better outcomes was seen as a positive and hopeful message by people from some communities. Clinicians expressed willingness to endorse the resources.

Regarding appropriateness, most community members agreed the resources were comprehensible and provided satisfactory explanations regarding CTs. The layout and imagery were widely considered to be presented in a culturally appropriate format, including the photographs depicting patients from diverse backgrounds. Suggested dissemination methods included the healthcare system, community groups, and ethnic media. Feedback resulted in refinement of language translations and provision of more detailed information on the linked web pages.

Conclusions: The in-language resources met the needs of the target audience and provided information in a culturally acceptable and appropriate way. This highlights the importance of providing appropriate in-language information to commonly under-served communities.

343 | Patterns of bowel cancer diagnosis, treatment and outcomes in relation to culturally and linguistically diverse (CALD) status in South Western Sydney Local Health District (SWSLHD)

Gui M Xiong^1,2, Christo Joseph³, Angela Berthelsen^1,2, Mahbuba Sharmin^1,2, Nasreen Kaadan^1,2, Joseph Descallar^2,4, Stephen Della-Fiorentina¹

¹Cancer Services, SWSLHD, Liverpool, NSW, Australia

²Ingham Institute, Liverpool, NSW, Australia

³Western Sydney University, Campbelltown, NSW, Australia

⁴SWSLHD, Liverpool, NSW, Australia

Background: The 2022–2027 NSW Cancer Plan identified multicultural communities as being a key group disproportionately affected by cancer.¹ CALD populations commonly face significant challenges when accessing healthcare which leads to health disparities when compared to non-CALD populations.² The reasons for these disparities are varied.^3,4 SWSLHD hosts a significant multicultural population with 43.3% born overseas and 45.3% speaking a language other than English at home.⁵

Aim: To investigate the impact of CALD status on extent of disease at presentation and treatment patterns in SWSLHD's bowel cancer patients.

Method: A retrospective analysis of patients who had an encounter with SWSLHD Cancer Services and were diagnosed with a primary bowel cancer between 1 January 2013 and 31 December 2022.

A multivariate logistic regression model accounting for CALD status, age, gender, socioeconomic status (SES) was used to analyse extent of disease and treatment patterns variations.

Results: The model found no statistical significance when considering extent of disease against CALD status. However, there was a statistically significant result for SES (p = 0.019), with the most disadvantaged (quintiles 1–2) being more likely to have distant metastasis or recurrent disease (OR:1.202, CI95%:1.030–1.403).

The model found no statistically significant difference between receiving any treatment modality and CALD status. However, the most disadvantaged quintiles were more likely to receive any form of treatment compared to the more advantaged quintiles, with statistically significant results found for radiotherapy (p = 0.036) and palliative care (p ≤ 0.001).

Conclusion: CALD status was not found to be significantly associated with extent of disease or treatment patterns in SWSLHD's bowel cancer patients. Unlike CALD status, SES was a statistically significant predictor for having distant metastasis or recurrent bowel disease and for receiving radiotherapy and palliative care interventions for the advanced disease.

References:

1. Cancer Institute NSW (2022) NSW Cancer Plan 2022–2027. Available at: https://www.cancer.nsw.gov.au/getmedia/9b902aa8-329d-42f9-94db-8ecede00fd1e/CINSW-NSW-Cancer-Plan-Dec2023-web.pdf. Accessed: August 5, 2024.

2. Australian Institute of Health and Welfare (2022) Reporting on the health of culturally and linguistically diverse populations in Australia: an exploratory paper. Available at: https://www.aihw.gov.au/reports/cald-australians/reporting-health-cald-populations/summary. Accessed August 5, 2024.

3. Alananzeh I, Levesque J, Kwok C, Everett B. Integrative review of the supportive care needs of Arab people affected by cancer, Asia-Pac J Oncol Nurs. 2016;3(2):148-156. doi:10.4103/2347-5625.177396

4. Sze M, Butow P, Bell M, et al. Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables, Oncologist. 2015;20(5):523-531. doi: 10.1634/theoncologist.2014-0274

5. SWSLHD Planning Unit (2023) South Western Sydney Local Health District: Health Snapshot. Available at: https://www.swslhd.health.nsw.gov.au/planning/content/pdf/CommunityHealthProfile/SWSLHD_Health_Snapshot_Updated_December_2023-v1.2.pdf. Accessed August 5, 2024.

345 | Building regional clinical trial capacity and identifying unmet needs: 10-year audit of medical oncology clinic trials activated at the Sunshine Coast University Hospital and Health Service (SCHHS)

Betty Y. Zhang¹, Carrie Donohoe², Christelle Catuogno², Cassie Turner¹, Bryan A. Chan^1,3,4

¹Department of Medical Oncology, Cancer Care Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia

²Sunshine Coast University Hospital, Oncology Clinical Trials Unit, Birtinya, QLD, Australia

³School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia

⁴Centre for Bioinnovation, University of the Sunshine Coast, Sippy Downs, Queensland

Background: Clinical trials are routinely recommended as gold standard treatment options by most cancer guidelines. Ensuring equity of access to trials in regional and remote health services is an important quality indicator of cancer services delivery in regional Queensland. Thus, identification of current clinical trial capacity and unmet areas of need is important.

Methods: We performed an audit of medical oncology clinical trials activated at Sunshine Coast Hospital and Health Service (SCHHS) over a 10-year period. We reviewed the number of oncology clinical trials activated per year, by trial sponsor, by phase and tumour stream. A comparison of the growth in clinical trial numbers over years, along with corresponding principal investigators.

Results: A total of 56 trials recruiting 271 patients, were activated between 2014 and July 2024. Half were commercially sponsored (54%). Most trials were interventional studies (86%); 7% were related to biomarker discovery.

Phases 2, 3 and 4 trials comprised 34%, 52% and 2% respectively. No Phase 1 trial had been activated.

77% of trial patients (209/271) were enrolled into just three tumour streams – breast (14 trials), genitourinary (12 trials) and lung (13 trials). Patients with least access to trials included: central nervous system cancers (0 trial), gynaecological cancers (1 trial), upper gastrointestinal cancers and hepatobiliary cancers (2 trials each). Only 2 trials utilised the Teletrial model of care.

Conclusion: The total number of trials have greatly increased over the 10-year period, however, there is unequal access. Patients with breast, lung and genitourinary cancers had the widest access to clinical trials whilst those with gastrointestinal and rarer cancers were under-represented in trials. Only 2/56 trials have had a TeleTrial model of care. This audit highlights a significant area of need for patients.

346 | Practical guidance for preparing and conducting hybrid focus groups and online interviews with consumers for cancer research

Xanthia E. Bourdaniotis¹, Susannah K. Ayre^1,2, Leah Zajdlewicz¹, Belinda C. Goodwin^1,3,4, Elizabeth (Lizzy) A. Johnston^1,2,5

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

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

³Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia

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

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

Aims: While detailed methodological guidance is available for analysing data from focus groups and interviews, practical advice for how to recruit, prepare, and conduct these sessions, particularly in hybrid formats (i.e., online and/or in-person), is limited. Based on our experience recruiting a diverse sample of consumers to co-design and test study materials for a population-based cancer survivorship study, we provide practical recommendations for recruiting, preparing for, and conducting focus groups and interviews with community members for cancer research.

Method: After conducting 15 hybrid focus groups and 20 online interviews with 52 consumers (27% rural/remote, 15% born overseas, 6% Aboriginal and Torres Strait Islander), we reviewed our protocols, recruitment documentation, field notes, and session transcripts to identify effective strategies for recruiting a diverse sample and supporting meaningful and productive consumer engagement.

Findings: We created two resources with 11 recommendations for preparing and conducting hybrid focus groups and online interviews with consumers. The first resource provides a 6-item checklist for session recruitment and preparation with practical examples for how to complete each item: (i) define and document recruitment procedures, (ii) use multiple recruitment methods to recruit a diverse sample, (iii) implement multiple strategies to prevent and detect fraudulent online sign-ups, (iv) offer flexible participation options, (v) develop and pilot visual session materials, and (vi) nominate lead and support facilitators (focus groups only). The second resource provides five practical strategies for conducting the sessions with examples for how to implement these in practice: (i) allow time to get started, (ii) invite focused participation, (iii) keep track of time, (iv) facilitate productive and insightful conversations, and (v) debrief after sessions for continuous quality improvement.

Implications: These resources can support students, researchers, and healthcare professionals to optimise consumers’ experience of participating in cancer research, ensuring consumer engagement is meaningful and productive for all.

347 | Development of standardised digital onboarding pathways for cancer nurses

Olivia Cook^1,2, Kylie McCormack¹, Lisa Burrell³, Emma Henning³, Renee Tregonning³, Marcus Vinski¹, Joanne Lovelock¹, Sue Bartlett^4,5, Jemma Still⁵

¹McGrath Foundation, Sydney, NSW, Australia

²Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia

³Androgogic, Leichhardt, NSW, Australia

⁴Grampians Health, Ballarat, VIC, Australia

⁵Cancer Nurses Society of Australia, Gabbadah, WA, Australia

Introduction: As part of the Australian Cancer Nursing and Navigation Program, 100 new cancer nurse positions will be placed through the McGrath Cancer Care Nurse (MCCN) Program from 2025 to 2027. MCCNs commence these roles with diverse qualifications, skills and experience. A recently developed Onboarding Pathway for McGrath Breast Care Nurses was modified and expanded to create an efficient and customisable onboarding experience for new MCCNs that accommodates individual learning needs across all cancer types.

Methods: A working group of cancer nurses, educators, peak body representatives, administrators and educational technologists designed, developed and tested the tasks and milestones that made up each onboarding pathway. Collaborations with key cancer education providers were formed to map and source existing evidence-based education content for inclusion in the pathways. Each pathway was designed to build the confidence and capability of nurses over time and connect them to the services and resources required to provide optimal care. An implementation evaluation of the onboarding program including pre- and post-nursing skills measures and real-time feedback will commence in October 2024 and inform an iterative approach to improvement.

Results: Two pathways were developed – (1) Associate MCCN pathway - for nurses new to specialist cancer nurse roles, not yet post-graduate qualified (18 months duration); (2) MCCN Pathway – for nurses who are post-graduate qualified and experienced in specialist cancer nursing (12 months duration). Each pathway consists of a combination of administrative and learning tasks including post-graduate study within the Associate MCCN pathway. Within each pathway, digital program logic empowers nurses to self-direct their learning and guide them through each milestone efficiently.

Conclusion: The pathways ensure new MCCNs receive the required learning and support to deliver care, while creating efficiencies in the MCCN Program. The use of digital onboarding pathways allows for standardised preparation of the workforce across the country.

348 | Understanding the value of codesign: Exploring participant experiences

Vicki Durston¹, Sarah Dwyer¹, Siobhan Dunne¹, Victoria White²

¹Breast Cancer Network Australia, Richmond, VIC, Australia

²Deakin University, Melbourne, VIC, Australia

Introduction: The Australian Cancer Plan (ACP) emphasises the importance of co-design. Breast Cancer Network Australia (BCNA) frequently collaborates with health professionals and consumers in co-design initiatives. Although codesign projects are increasingly reported, few studies have explored the experiences of participants.

Methods: Qualitative interviews with Lived Experience (LE) and External Stakeholder (ES) participants in two codesign projects; (1) development of a survey assessing BCNA information and support service needs for those with breast cancer and (2) a roundtable to progress advocacy to improve metastatic cancer data in Australia. A random sample were invited to participate in semi-structured interviews. Interviews were recorded, transcribed and thematic analysis undertaken. Findings were compared to existing guidelines and principles for co-design.

Conclusions: Participating in codesign projects was a positive experience for LE and ES. The findings highlighted factors that contribute to successful codesign projects and confirmed that BCNA's approaches adhere to best practice guidelines and principles. This research can help inform the codesign practices of other organisations ultimately, improving the planning, implementation and evaluation of cancer policy, research, and information services, thereby enhancing health outcomes for people affected by cancer.

349 | An evaluation of the acceptability and feasibility of the alternative access model for bowel cancer screening among Mandarin speaking Chinese residents and Mandarin speaking health practices

Lanxi Huang¹, Joyce Jiang¹, Carlene Wilson¹, Jennifer McIntosh¹, Mark Jenkins¹, Belinda Goodwin^1,2

¹University of Melbourne, Carlton, VIC, Australia

²Cancer Council Queensland, Fortitude Valley, QLD, Australia

Aims: This study aims to determine the acceptability, feasibility and sustainability of the Alternative Access Model (AAM), recently rolled out by the National Bowel Cancer Screening Program (NBCSP), within the Mandarin-speaking Chinese community and among primary healthcare providers serving this population. Through a co-design approach, we seek to identify barriers to and facilitators of AAM utilization and develop strategies to optimize its implementation, enhancing both participation and sustainability.

Methods: The co-design approach includes 20–30 semi-structured interviews with healthcare providers and 10 interactive focus group discussions with Mandarin-speaking community members (n = 80–100). Following this, we will undertake two surveys, one targeting Mandarin-speaking healthcare providers to assess the acceptability, feasibility, and sustainability of the recommendations; and the other surveying Mandarin-speaking consumers to explore factors influencing their response to the AAM, such as cancer knowledge and health attitudes.

Results: Preliminary results indicate that while there is limited awareness of the AAM among general practitioners (GPs), practice nurses, and practice managers, there is significant interest in its adoption. Offering materials in patients’ native languages and providing technical support for integration of software clinic is using and the portal required by AAM are crucial. Focus groups with Chinese community members reflect a strong commitment to proactive health measures, though issues with kit delivery and delays persist. Enhancing instructions in consumers’ native language, and leveraging GPs endorsement, alongside promoting the program through social media platforms (e.g., WeChat) commonly used by community members and community events, are key strategies for improving engagement and effectiveness.

Conclusion: Strategies developed through co-designing with health professionals and community members will improve navigation and participation in the NBCSP, hence, increased uptake bowel cancer screening. Findings and strategies from the study will provide insights and can be replicated in other culturally diverse communities, promoting equitable and better health outcomes for all Australians.

351 | Reflective and reflexive practices in tertiary healthcare students following cancer patient engagement: A scoping review

Daniel Johnstone^1,2

¹The University of Adelaide, Adelaide, SA, Australia

²Cancer Voices South Australia, Forestville, SA, Australia

The lived experience of those impacted by their own cancer diagnosis provides a valuable resource and expertise that can be used in the education of healthcare students. For students, the use of reflective practices is commonly used throughout education to enhance student learning following clinical placements or engaging with various patient populations. What is not currently understood is how such practices are influencing students when used following engagement with those impacted by cancer. This scoping review explored how reflection practices have been utilised by healthcare students after engaging with a person of a lived experience of cancer, and the impact of those reflective exercises.

Eligible publications included tertiary level healthcare students in a discipline that may be involved within the cancer landscape and undertook some degree of reflection or reflexivity following engagement with a person of a lived experience of cancer in the clinical or education setting. Sources included published works and gray literature, but only those written in English.

The scoping review method set out by the Joanna Briggs Institute (JBI) was adopted along with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Database searches included MEDLINE, Emcare, Scopus, CINAHL, PsycINFO and ERIC (ProQuest). Results are presented by way of narrative synthesis. 11,814 studies were screened, with 42 papers undergoing full-text review and 19 papers being included in the review.

Findings supported that patient interaction coupled with reflective practices, benefited students. It assisted in developing empathy, understanding the patients’ perspectives, and facilitated emotional resilience, leading to improved attitudes toward patient-centred care. More research is needed that utilises established theoretical frameworks in reflective practices, couples outcome measures with quantitative findings, and exploration of how learning from lived experience in the clinical setting compares to the classroom setting.

352 | Patient–teachers: A cancer-consumer informed approach to using their stories in the education of healthcare students

Daniel Johnstone^1,2

¹Cancer Voices South Australia, Forestville, SA, Australia

²The University of Adelaide, Adelaide, SA, Australia

Those who are experiencing, or have experienced cancer, can provide significant insight from which we can learn about the experience of cancer. Whilst this expertise is used across a wide-range of settings, including in education, there is a significant lack of understanding as to how those of lived experience wish to use their stories when educating students.

This study explored how those with a lived experience of cancer would use their stories when delivering an oral narrative of their experience to students. Twenty-one participants (6 male, 15 female), with a lived experience of cancer took part in semi-structured interviews. The results were completed using Covidence and presented by way of narrative synthesis. Topics of exploration included, but were not limited to, motivations for telling their story, the setting in which they wish to speak, themes of importance in their story, what they didn't want to talk about, the outcomes they wanted for those hearing their story, and the support services needed to help them in delivering their stories.

The findings of this study provide support for how those with a lived experience of cancer would inform an approach to healthcare student education when given complete autonomy to the delivery and outcomes of sharing their stories. These findings are important in continuing to understand the needs and desires of those with lived experience, how to best utilise their stories, and how to support them as we continue to work towards partnerships that promote increasing engagement of those of lived experience of cancer to inform the education for students and patient care in the cancer space.

353 | eviQ: Taking a BiTE^® into advanced therapies

Aisling Kelly¹, Aimee Russell¹, Julia Shingleton¹, Kelly Conway¹, Jenny Tran¹, Shelley Rushton¹

¹Cancer Institute NSW, Sydney, NSW, Australia

Introduction: As bispecific antibodies (BsAbs) gain prominence in cancer treatment and expand from haematology to solid tumours, optimising their use and management becomes essential for improving patient outcomes. However, integrating BsAbs into clinical practice is challenging due to their complex safety profiles, including potentially life-threatening conditions like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which require rapid identification and management.

Aims: To assess the knowledge, practices, and confidence of multidisciplinary cancer clinicians regarding BsAbs. Capturing real-world experiences and identifying knowledge gaps guides resource development across the eviQ Program and aligns with our goal of ensuring clinicians are well-equipped with the necessary tools and knowledge to manage BsAb therapy effectively and enhance patient care.

Methods: We conducted a national survey of cancer clinicians to assess their knowledge, practices, and confidence regarding BsAbs. Participants were asked about their roles, experience with BsAbs, and challenges in integrating these therapies into clinical practice.

Results: Of the 74 survey respondents, five were excluded as non-clinical participants. The remaining cohort comprised 14 medical professionals, 29 nurses, 24 pharmacists, and 2 individuals in other roles. Among them, 43% reported caring for patients receiving BsAbs, while 29% did not, and 28% did not respond. As expected, 47% of respondents were from metropolitan public hospital settings. Key themes included managing CRS and ICANS, varied confidence levels, and a need for improved education and standardised protocols, with a noted lack of national standards and inconsistent institutional practices.

Conclusion: As cancer treatments advance, eviQ's role in standardising protocols is crucial. The survey highlights the need for uniform BsAb therapy protocols and better education. We've identified key resources and formed a working group to develop universal and product-specific information. Centralised protocols reduce duplication, foster cross-specialty collaboration, enhance care quality, and allow clinicians to focus on patient care.

354 | ‘Feeling unwell’: A convergent parallel mixed methods survey of rural Western Australians’ perceptions of the most common cancer symptoms

Chloe M. Maxwell-Smith¹

¹Curtin University, Bentley, WA, Australia

Aims: With high cancer incidence in Australia, early diagnosis of cancer is a priority. The Cancer Council WA's Find Cancer Early campaign seeks to increase awareness of common cancer symptoms to promote early diagnosis of common cancers (skin, bowel, breast, prostate, and lung). While the campaign shows promise, there may still be issues with surveillance, resulting from misconceptions about common cancer symptoms. This study aimed to explore regional and rural Western Australians’ beliefs about the most common cancer symptoms.

Methods: A convergent parallel mixed methods approach was employed. Computer-assisted telephone interview (CATI) surveys completed with rural Western Australians (n = 1051) age 40 and over. Respondents were asked to list the most common cancer symptoms and interviewers coded responses according to the ten most common symptoms of the five most common cancers, with beliefs falling outside evidence-based symptoms left as open text and analysed with summative content analysis.

Results: Survey respondents averaged 61 years old (SD 11.89), with 53% identifying as a woman and 6% identifying as Aboriginal or a Torres Strait Islander. Respondents identified an average of 1.43 (SD 1.28; range 0–6) of the ten most common cancer symptoms without any prompts. An open-ended question about common cancer symptoms beliefs revealed that many consider feeling generally unwell, along with skin bruising/itching, dizziness, and lethargy to be indicative of cancer.

Conclusion: While current initiatives are running to promote early diagnosis of common cancers, there is scope to target public health campaigns. An initiative promoting awareness of one-off symptoms and dispelling myths about symptoms may harness potential for early diagnosis, particularly in regional and rural communities.

355 | Feasibility and value of a guided observation and reflection learning activity for medical students on clinical placement in cancer care

Erin Moth^1,2, Sath Narayanan^1,2, Jenny Gilchrist^1,2, Abby Fyfe², Janani Mahadeva^1,2, John Turchini¹

¹Faculty of Medicine, Health, and Human Sciences, Macquarie University, NSW, Australia

²Macquarie University Hospital, Macquarie University, NSW, Australia

Background: Placements in cancer care can be confronting and academically challenging for students. Reflection in medical education enhances learning of complex content, facilitates emotional expression, and augments professional values.

Aim: To determine whether a reflective practice learning activity (i) is feasible and acceptable to students, and (ii) improves reflective capacity.

Methods: Year 2 Macquarie University medical students completing 4-week placements in Cancer Care were asked to complete an unassessed written reflection using a guided tool for two observed clinical encounters. Students then attended a clinician-facilitated small-group discussion. Discussion was directed by students’ reflections and anchored to learning outcomes. Feasibility of Intervention (FIM), Acceptability of Intervention (AIM), and Intervention Appropriateness (IAM) measures¹ were completed as part of an evaluation survey. After feasibility ‘run-in’ (rotation 1), rotations 2 and 3 students completed the Reflective Practice Questionnaire's 16-item reflective capacity subscale (RPQ-RC)² at baseline and end-of-placement, with mean scores (range 1–6) compared (paired t-test).

Results: Of 58 students, 81% submitted written reflections, 95% attended group discussion, and 67% completed evaluation surveys. Reflections took a median of 25 minutes (IQR = 15–30). Mean rating for the learning activity (anchors ‘poor’ to ‘excellent’) was 84 out of 100 (range 61–100). Most students agreed or strongly agreed that the learning activity was valuable (95%), improved understanding of placement experiences (98%), and prompted learning (88%). Students perceived the learning activity feasible (mean FIM 4.39 out of 5), acceptable (mean AIM 4.43 out of 5), and appropriate (mean IAM 4.53 out of 5). For 25 rotation two and three students with paired RPQ-RC data, there was a significant increase in ‘reflective capacity’ from baseline to end-of-placement (mean baseline RPQ-RC 4.15, end-of-placement 4.82, t-stat = 5.78, p < 0.00001, Cohens d = 1.15).

Conclusion: Guided observation and reflection within Cancer Care clinical placements is feasible and acceptable to students, a valued learning activity, and enhances reflective capacity.

References:

1. Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017;12(1):108. doi: 10.1186/s13012-017-0635-3. PMID: 28851459; PMCID: PMC5576104.

2. Rogers SL, Van Winkle L, Michels N, et al. Further development of the reflective practice questionnaire. PeerJ. 2024;12:e16879. doi: 10.7717/peerj.16879. PMID: 38344297; PMCID: PMC10859078.

357 | Malnutrition and sarcopenia in cancer: An eLearning program refresh

Hannah Ray¹, Jane Stewart¹, Rebecca McIntosh¹, Lauren Atkins², Samantha Chandler³, Kathryn Cirone⁴, Keith Donohoe³, Andrea Elliott⁵, Frezsa Fulia⁶, Lauren Hanna⁷, Nicole Kiss⁸, Tanith Lamaro⁹, Rebecca Nunes¹⁰, Caroline Owen⁴, Kathryn Pierce¹¹, Kathy Quade⁶, Liz Simkiss¹², Natalie Simmance¹³, Wendy Swan¹⁴, Jenelle Loeliger^1,15,16

¹Nutrition department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

²OnCore Nutrition, Melbourne, VIC, Australia

³Consumer Register, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Centre for Cancer Education, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁵Nutrition department, Alfred Health, Melbourne, VIC, Australia

⁶WCMICS, Melbourne, VIC, Australia

⁷Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia

⁸IPAN, Deakin University, Melbourne, VIC, Australia

⁹Access Health and Community, Melbourne, VIC, Australia

¹⁰Nutrition department, Grampians Health, Grampians, VIC, Australia

¹¹Western Health, Footscray, VIC, Australia

¹²Victorian Government, Melbourne, VIC, Australia

¹³St Vincent's Hospital, Melbourne, VIC, Australia

¹⁴Goulburn Valley Health, Goulburn Valley, VIC, Australia

¹⁵School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia

¹⁶Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

Background: Cancer malnutrition and sarcopenia remain significant but potentially reversible health concerns associated with poor clinical outcomes and high healthcare costs. The Malnutrition in Cancer eLearning program was developed in 2014 to provide education to multidisciplinary clinicians to improve recognition, understanding and management of malnutrition. The aim of the refresh was to update The Malnutrition in Cancer eLearning program, then test and evaluate its useability and acceptability.

Methods: A literature search of eLearning education and evidence for cancer malnutrition and sarcopenia was conducted. Representatives from a range of Victorian health settings were invited to participate in workshops to gain consensus on updates to the program. Participants reviewed the program content, learning objectives and target audiences, identified content modifications and new topics for inclusion. Participants completed end-user testing including system usability scale (SUS), a survey based on the theoretical framework of acceptability (TFA) and a study-specific survey pre- and post-program update.

Results: Ten health professionals representing general practitioners, education specialists, dietitians from metropolitan, regional and community settings, nursing and speech pathology, participated in the eLearning refresh. Key consensus points included reducing program length, improving visual appeal, increasing interactivity and incorporating sarcopenia content. End-user testing indicated acceptability of the program improved from 3.4 to 4 (TFA average), and usability improved from 67.8 to 79.2 (SUS average) post refresh.

Conclusion: The eLearning program refresh was completed through a robust review process.

End-user testing demonstrated a highly useable and acceptable program. The program provides free accessible education for health professionals via eviQEd website https://education.eviq.org.au/courses/supportive-care/malnutrition-and-sarcopenia-in-cancer to reduce cancer malnutrition and sarcopenia burden in our community.

Funding source: this project was funded by the Victorian Department of Health.

Conflict of interest: The authors declare they have no conflicts of interest.

358 | Cancer nursing: Not a nursing speciality in Papua New Guinea

Pauline M. Rose¹

¹Volunteer Cancer Nursing Educator (Remote), Port Moresby General Hospital, Port Moresby, Papua New Guinea

Background: In 2021 I began teaching cancer nursing remotely via ZOOM for a few nurses in Port Moresby General Hospital (POMGEN) in preparation for their new Cancer Centre. I expected that the education would continue for a period of time and once the Centre opened others would take over. Three years later the Cancer Centre is not open, and weekly tutorials are still provided on cancer nursing, not only to those original RNs, but to many interested nurses across Papua New Guinea (PNG) in lieu of any other cancer education.

Aim: This paper reflects on issues affecting the recognition of cancer nursing as a specialty in PNG.

Reflections on Remote Teaching: Network instability, the didactic nature of ZOOM presentations, and poor feedback from shy nurses, made evaluation of the tutorials difficult. Understanding comprehension levels was initially a challenge. Nurses had limited access to internet, no textbooks, and were unused to structured cancer education; most in the provinces still use their mobiles and own data for tutorials. A positive intervention was the creation of the PNG Oncology Nurses Association, providing a voice about cancer issues for the first time.

Reflection on Future Directions: In 2021 my initial communication was with clinical oncologists; thereafter I included the Director of Nursing of POMGEN in communications, as nursing needs were barely considered in the new Cancer Centre. Many nurses in PNG work with cancer patients, and some nurses administer chemotherapy with limited education. Most cancer patients present with advanced disease due to fear, sociocultural/financial issues, including the cost of travel to treatment. There is no Chief Nursing Office in the Department of Health, creating challenges in obtaining recognition of cancer nursing as a specialty. Important for future sustainability will be the introduction of a post-basic Bachelor of Oncology Nursing course through the University sector.

359 | Building capability: The experience of a delegate from Papua New Guinea with cancer pharmacist education delivered by Clinical Oncology Society of Australia's Cancer Pharmacists Group

Marissa Ryan^1,2,3, Sarah Heward⁴, Narelle Carnazzola^5,6, Kosar Latif², Hayley Vasileff⁷, Christy Wai⁸

¹Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia

²Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia

³Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia

⁴Cancer Services, WA Country Health Service, East Perth, WA, Australia

⁵Pharmacy Department, Townsville University Hospital, Townsville, QLD, Australia

⁶College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

⁷SA Pharmacy, SA Health, SA, Australia

⁸Port Moresby General Hospital, Port Moresby, Papua New Guinea

Aim: To describe the experience of a delegate from Papua New Guinea (PNG) attending the Clinical Oncology Society of Australia (COSA) Cancer Pharmacists Group (CPG) Foundation Clinical Skills Course in Australia as part of a mentorship program.

Method: The delegate provided a written summary of their course attendance experience which included pre-recorded online presentations and interactive face-to-face sessions over two days. COSA CPG mentors analysed the summary to inform the benefits and opportunities for improvement of incorporating this learning opportunity into the mentorship model.

Results: The pre-recorded online content provided a useful review of the basics of cancer and its treatment. The delegate also reported the session on the clinical verification process of cancer treatment as very relevant. They noted the benefit of utilising the standardised verification process and felt equipped and empowered to apply this process into their everyday practice post-course. The benefit of interactive sessions and ample forums for discussions were highlighted. The opportunity to interact with other delegates was described as valuable with additional learnings through discussing experiences with other pharmacists. Particular practices prioritised for implementation in PNG include pharmacist clinical verification and additional involvement in treatment-related toxicities prevention and management to positively impact patient care. The delegate was cognisant of their need for continued professional development.

Conclusion: Building capability of clinicians from low- and middle-income countries is one of COSA's priorities. It is also a priority for COSA's Global Oncology Group and CPG. Facilitating cancer pharmacist education for the delegate was aligned to this priority. The format and content of the course provided a practical platform to continue to develop, learn, and improve practice in PNG. The delegate plans to impart knowledge gained from the course with their colleagues and into their everyday practice to contribute towards better outcomes for patients with cancer in PNG.

360 | eviQ: Increasing community pharmacy knowledge of anti-cancer medicines

Julia V. Shingleton¹, Aisling P. Kelly¹, Jenny Tran¹, Philippa M. Smith¹, Shelley A. Rushton¹

¹Cancer Institute NSW, St Leonards, NSW, Australia

Introduction: Recent years have seen significant growth in the number of oral anti-cancer medicines. These medicines are increasingly being dispensed and used in the community setting. Community pharmacists are ideally positioned to contribute to the safe and optimal use of oral anti-cancer medicines. Community pharmacists have not traditionally been involved in the provision of anti-cancer treatment and therefore have not previously been a key audience for eviQ¹ and eviQ Education².

Aims: To develop tailored resources and engage with community pharmacists, to increase their awareness of the complexities of oral anti-cancer medicines, empowering them to deliver safe and optimal patient care.

Methods: A landscape analysis was completed, demonstrating a lack of comprehensive education resources on anti-cancer medicines for community pharmacists. Following this, eviQ and eviQ Education have focused on developing education resources and conducting activities to address this gap. Fostering relationships with key community pharmacy stakeholders has also been a priority.

Results: The free online course ‘Oral anti-cancer drugs in community pharmacy’³ was developed with key pharmacy stakeholder collaboration. It is CPD accredited and hosted by peak pharmacy professional bodies The Pharmacy Guild of Australia and Pharmaceutical Society of Australia, and community pharmacy retail group Chemist Warehouse.

eviQ fact sheets designed specifically for community pharmacists on oral anti-cancer treatments^4,5 were also developed.

eviQ pharmacists provide annual lectures and workshops to pharmacy students at the University of Technology Sydney and Sydney University, reaching ∼160 students annually.

eviQ pharmacists provide annual education sessions for the Chemist Warehouse retail group, reaching ∼3400 pharmacy interns and pharmacists annually.

Conclusion: As the national provider of evidence-based cancer treatment information and education, eviQ and eviQ Education are uniquely placed to support community pharmacists to ensure safe and optimal use of oral anti-cancer medicines. Initial successes indicate engagement activities could be expanded to reach more Australian community pharmacists.

1. https://www.eviq.org.au/

2. https://education.eviq.org.au/

3. https://education.eviq.org.au/courses/pharmacy/oral-anti-cancer-drugs-in-community-pharmacy

4. https://www.eviq.org.au/clinical-resources/health-professional-fact-sheets/3075-pharmacist-fact-sheet-oral-anti-cancer-drug

5. https://www.eviq.org.au/clinical-resources/health-professional-fact-sheets/3073-pharmacist-fact-sheet-managing-common-adver

361 | Implementing a pharmacist-led education initiative to improve rates of allergy recording in CHARM

Ashleigh Smith¹, Braedon Denham¹, Samuel Beale¹

¹Queensland Health, Toowoomba, QLD, Australia

Background: Incomplete or inaccurate drug-allergy histories can significantly increase the risk of patient harm. Due to the infrastructure and varying uses for software within Queensland Health, not all information will be carried through from one system to the next. CHARM is a stand-alone system used to prescribe anti-cancer therapy and supportive medicine in the cancer space- allergies are manually input into CHARM by users.

Aims: To improve allergy recording rates in CHARM prescribing software.

Methods: all patients receiving anti-cancer therapy or supportive therapy in CHARM during a 28-day audit period were analysed across both CHARM and iPharmacy to determine consistency and accuracy of allergy recording across the systems. Subsequent nursing and pharmacist education sessions will be implemented to support staff in competency to enter allergy information in CHARM. A survey will be conducted with health professionals partaking in the education sessions to explore barriers and enablers to routine allergy recording in CHARM. A post-interventional audit will be carried out over a subsequent 28-day period to determine the percent improvement in allergy recording.

Results: In the pre-interventional audit, 544 patient profiles were analysed. 27% of patients had complete allergy information recorded in CHARM. iPharmacy recordings were observed in 39% of patients. When looking at patients confirmed as having nil known allergies (NKA), 1.5% of patient profiles in charm and 3% of patient profiles in iPharmacy had documentation recorded. The interventional period will be underway in August 2024, with repeat auditing to be carried out in October 2024 to present at COSA ASM.

Conclusions: COSA guidelines for the Safe Prescribing, Supply and Administration of Cancer Chemotherapy stipulate that patient allergies are among the list of information that must be included on a chemotherapy order. Through education and promotion of best practice, our centre target is to reach 100% allergy recording in CHARM.

362 | ANZGOG community engagement program – How lived experience can shape future directions in gynaecological cancer research, advocacy and education

Bree Stevens¹, John Andrews¹, Aimhirgin Byrne1, Karen Livingstone AM¹, Paul A. Cohen^1,2, Clare L. Scott AM^1,3,4

¹ANZGOG, Camperdown, NSW, Australia

²University of Western Australia, Perth, Australia

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

⁴Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia

Introduction and Aims: More than 8000 women are diagnosed with a gynaecological cancer in Australia and New Zealand each year.^1,2 Gynaecological cancer survivors and caregivers are in a unique position to share personal insights to shape future directions in gynaecological cancer research, advocate for research funding and educate the next generation of health professionals.

Recognising the importance of the consumer voice, the Australia New Zealand Gynaecological Oncology Group (ANZGOG) sought to develop a Community Engagement Program (CEP) that provides opportunities for people with a lived experience of gynaecological cancer to contribute meaningfully and effect outcomes for gynaecological cancer patients now and into the future.

Methods: ANZGOG undertook a process of discovery regarding best practice in community engagement to define the strategy and framework to provide meaningful opportunities for volunteer contribution. Development of the CEP was informed by extensive consultation with stakeholders, ANZGOG members, community volunteers and organisations with significant experience in consumer partnerships.

Results: Consultation confirmed that ANZGOG's CEP will provide opportunities for people with a lived experience of gynaecological cancer (n = 123) to contribute across three pillars: Education, Advocacy and Research – based upon individual areas of interest, or expertise, by matching volunteers with the pillar most suited to them. It was considered essential that volunteers are provided with training and ongoing support to fulfill their role.

Conclusion: The design of the CEP ensures ANZGOG's strategies, priorities and activities are informed by, and reflect, the diverse needs of people with a lived experience of gynaecological cancer.

1. https://www.canceraustralia.gov.au/cancer-types/gynaecological-cancers/statistics

2. https://www.health.govt.nz/publication/new-cancer-registrations-2019

363 | From toxicity to recovery: A case report of a patient administered glucarpidase for methotrexate toxicity

Michael Whordley¹, Gail Rowan², Fiona Swain^1,3, Thomas Trevis¹, Marissa Ryan^1,4,5

¹Princess Alexandra Hospital, Brisbane, QLD, Australia

²Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

³Frazer Institute, The University of Queensland, Brisbane, QLD, Australia

⁴Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia

⁵Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia

Aim: To describe high-dose methotrexate toxicity management in a 28-year-old male of mixed ethnicity with MRD+ Early T-cell Precursor Acute Lymphoblastic Leukaemia admitted to a Brisbane hospital for ALL06 high-risk block 1 pre-allograft.

Method: A retrospective case review was conducted including examination of the patient's parameters, treatment, and methotrexate toxicity management.

Results: The patient's BSA was 2.48 m² with a height of 188 cm and weight of 118 kg. Methotrexate 5 g/m² was administered intravenously over 24 h. The 24-h level cleared (<150 mmol/L), however the 36-h level was raised at 15 mmol/L (aim is <3 mmol/L). An acute kidney injury developed with serum creatinine increasing from 73 mmol/L to 172 mmol/L and 12 kg weight gain in fluid. Administration of glucarpidase 50 units/kg intravenously 48–60 h post-methotrexate is recommended if serum creatinine is >1.5x upper limit of normal (or ≥2x patient baseline) with elevated methotrexate level. Glucarpidase converts extracellular methotrexate into its inactive metabolites, glutamate and DAMPA (4-deoxy-4-amino-N10-methylpteroic acid) to minimise life-threatening toxicities. The 42-h level was 11 mmol/L (aim is <1 mmol/L) and 48-h level was 7.8 mmol/L (aim is <0.4 mmol/L). Calcium folinate rescue and sodium bicarbonate were administered as per protocol with diuretics required for fluid overload. The pharmacist liaised with a pharmacist at Peter MacCallum Cancer Centre (PMCC) in Melbourne regarding glucarpidase availability and dosing experience. The number of glucarpidase vials required exceeded the number available. The pharmacist discussed the availability, prior experience with a 2000 units capped dose, and pharmacokinetics with the haematology team and subsequently organised two 1000 units vials from PMCC. There was a significant reduction in methotrexate levels following glucarpidase administration, however level interpretation was difficult due to both DAMPA cross-reactivity with the immunoassay and fluid shifts. Regain of normal renal function occurred within 4 weeks.

Conclusion: The glucarpidase 2000 units capped dose was deemed efficacious as part of methotrexate toxicity management.

364 | Data sharing in cancer research: A qualitative study exploring community members’ preferences

Susannah K. Ayre^1,2, Lizzy A. Johnston^1,2,3, Xanthia E. Bourdaniotis¹, Leah Zajdlewicz¹, Vanessa L. Beesley^4,5,6, Belinda C. Goodwin^1,7,8

¹Cancer Council Queensland, Brisbane, QLD, Australia

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

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

⁴Psychedelic Medicine and Supportive Care Lab, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

⁵School of Psychology, The University of Queensland, Brisbane, QLD, Australia

⁶School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia

⁷Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia

⁸School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia

Aim: Advancements in cancer treatment and survivorship rely on participation in research and access to health records. Yet, little is known about consumers’ preferences for how their data are used in cancer research and how studies could be designed to optimise data collection and sharing. This study explores community members’ preferences for use of their self-report data and health records in cancer research, and reasons underlying these preferences.

Methods: Fourteen workshops were conducted involving 42 community members, most of whom were a cancer survivor or caregiver. Various scenarios for data access and sharing were presented and discussed, with participants’ preferences summarised using descriptive statistics. Reasons underlying these preferences were identified through a thematic analysis of workshop transcripts.

Results: Most participants indicated a willingness for researchers to use their self-reported data and current health records for a specific research project (86%). Many were also willing to consent to their self-reported data and current (62%) or future (44%) heath records to be shared with other researchers for use in other studies if made aware of this. Willingness to consent to data access and sharing in cancer research was influenced by: (i) the potential for data sharing to advance medical knowledge and benefit people impacted by cancer in the future, (ii) transparency around researchers’ credibility and their intentions for data sharing, (iii) level of ownership and control over data sharing (particularly health records), and (iv) data sharing protocols for privacy and confidentiality.

Conclusions: These findings demonstrate community support for improved data access and sharing in cancer research, a priority for advancing cancer control. Incorporating community preferences into the design and conduct of cancer research studies has the potential to optimise community participation and the translation of research findings into practice.

365 | Endocrine treatment uptake and time to treatment commencement among women with breast cancer: A Queensland population-based study

Habtamu Mellie Bizuayehu¹, Ming Li¹, Shafkat Jahan¹, Gail Garvey¹

¹The University Of Queensland, Brisbane, QLD, Australia

Publish consent withheld.

366 | Heterogeneity in the distribution of cutaneous T-cell lymphomas (CTCL) across Australia mirrors dermatologist-density and highlights the unique challenges to diagnosis

Belinda Campbell^1,2,3, Peter D. Baade^4,5, Paramita Dasgupta^4,5, Jessica K. Cameron^4,5,6, Sandro V. Porceddu^6,7,8, Miles Prince^1,9, Karin Thursky^1,10

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

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

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

⁴Viertal Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia

⁵Cancer for Data Science, Queensland University of Technology, Brisbane, QLD, Australia

⁶Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

⁷Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁸Department of Radiology, University of Melbourne, Parkville, Victoria, Australia

⁹Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbouren Hospital, Melbourne, Victoria, Australia

¹⁰Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Aims: Cutaneous T-cell lymphomas (CTCL) are typically incurable, cause significant symptom burden and have a prolonged disease course. Unique hurdles to diagnosis arise from the disease rarity, overlapping morphological appearances, low skin biopsy rates, and requirement for clinico-pathological correlation. This study investigates the incidence and geospatial distribution of CTCL in Australia, compares the distribution to all rare cancers, and explores a possible relationship between CTCL incidence and dermatologist-density in Australia.

Methods: Patients with CTCL (diagnosed 1 January 2000–31 December 2019) were sourced from the Australian Cancer Database, a nationwide dataset of mandatorily reported cancers. Patients aged <15 years were excluded. Residential areas were categorized according to federally-defined definitions. Bayesian spatial incidence models were applied.

Results: The age-standardized incidence of CTCL in Australia was 7.7 [95%CI: 7.4–7.9] per million person-years, translating to 285 new cases annually.

Geospatial analyses revealed heterogeneity in the diagnosis rates of CTCL across small areas and between states/territories. Standardized incidence ratios (SIR) were higher than the national average in the more populated capital cities of Sydney, Melbourne, Perth, Brisbane, and especially Adelaide (11.0 diagnoses per million person-years (95%CI: 9.7–12.5)). Diagnosis rates were lower in rural/remote and socio-economically disadvantaged regions.

Notable geographical differences were seen when comparing the distributions of CTCL to all rare cancers, particularly in northern and central Australia and Tasmania where CTCL diagnoses were most rare. Consistencies between reported CTCL distribution and dermatologist-density were observed.

Conclusion: CTCL is rare, with incidence in Australia on the higher end of international reports. There is geographical variability across the country, with incidence often reflecting population density. Geospatial patterns of CTCL differed significantly from that of all rare cancers, highlighting the distinct diagnostic challenges and unmet needs of this patient group. Parallels between CTCL distribution and dermatologist-density suggest that diagnostic-scrutiny and access to specialist care may play critical roles at this national level.

367 | Allergic disease and risk of multiple myeloma in EMMA: A case-control study

Simon Cheah^1,2, Adrian J. Lowe², Nina Afshar^1,2, Julie K. Bassett¹, Wendy Cozen³, Simon J. Harrison^4,5, John L. Hopper², Harindra Jayasekara^1,2, Miles Prince^4,6, Claire M. Vajdic⁷, Nicole Wong Doo⁸, Graham G Giles^1,2,9, Shyamali C. Dharmage², Roger L. Milne^1,2,9

¹Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, VIC, Australia

²Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

³University of California, Irvine, California, USA

⁴Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

⁵Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia

⁶Epworth Healthcare, Melbourne, VIC, Australia

⁷Kirby Institute, UNSW, Sydney, NSW, Australia

⁸Concord Clinical School, University of Sydney, Sydney, NSW, Australia

⁹Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, VIC, Australia

Background and Aims: Multiple myeloma (MM) is a haematological malignancy responsible for significant morbidity, yet our knowledge regarding MM aetiology remains limited. This analysis investigated whether an history of allergic conditions was associated with MM risk.

Methods: Incident cases (n = 782) of MM were recruited mainly via cancer registries in Victoria and NSW. The controls included in the analysis (n = 733) were siblings (n = 436) or partners (n = 297) of cases. Unconditional multivariable logistic regression was used to estimate odds ratios (OR), 95% confidence intervals (CI) and p-values for associations between self-reported allergic conditions (asthma, eczema, food allergy, hay fever) and MM risk. Missing data was handled with multiple imputation and causal diagram analysis was used for covariate selection.

Results: We found an history of eczema was inversely associated with MM risk (OR = 0.54, 95% CI = 0.42–0.70), as was history of any allergic condition (OR = 0.68, 95% CI = 0.55–0.84). We found that compared with no history of allergic conditions, higher frequency of reported conditions was associated with increasingly lower estimated risk of MM; from one reported condition (OR = 0.76, 95% CI = 0.58–0.98), to four conditions (OR = 0.50, 95% CI = 0.23–1.09). No notable associations were identified for food allergy, asthma, or hay fever alone.

Conclusions and future directions: Our findings extend the knowledge of MM risk factor epidemiology in Australia. Research into potential underlying mechanisms might help explain disparate results of various studies examining the association between MM and allergic conditions.

368 | Cancer incidence and survival statistics by histological type: A new approach for reporting cancer data in Australia by the Australian Institute of Health and Welfare

Mark Short¹, Claire Cooke-Yarborough², Brent Bufton¹, Christina Hatsiz¹, Henry Wong¹, Justin Harvey¹, Wendy Erber³, Maher Gandhi⁴

¹Cancer Data and Monitoring Unit, Australian Institute of Health and Welfare, Canberra, ACT, Australia

²CINSW, St Leonards, NSW, Australia

³University of Western Australia, Perth, WA, Australia

⁴Mater Research, University of Queensland, Brisbane, QLD, Australia

Overview: Cancer groups traditionally used by the Australian Institute of Health and Welfare (AIHW) for reporting incidence and survival statistics were defined by the primary site of the cancer. Because treatment and survival can differ by histological type for a site, the AIHW has developed histological classifications for selected sites. The classifications are used for reporting cancer incidence and survival statistics stratified by site and histology on the AIHW website.

Details: Since 2022, the AIHW has been reviewing site-histology combinations that occur in the Australian Cancer Database. For combinations deemed unlikely, the Australian population-based cancer registries (PBCRs), who provide these data annually to AIHW, were asked to review their cases and, if necessary, provide corrected data. A customised histological classification was then developed for each of the selected sites/types. As far as possible the classifications were aligned with the most recent World Health Organization (WHO) classifications available (4th or 5th edition) but PBCR data contain many more histological codes than are discussed by the WHO.

The data are available to the public in an online data visualisation tool:

https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-incidence-and-survival-by-histology-selecte

Users select a site and histology group and can then see graphs of incidence and survival trends over time since 2001. For example, 5-year relative survival for pancreatic cancer during 2015–2019 was 12.5%, but restricted to adenocarcinoma (65% of cases) or neuroendocrine neoplasms (10%), survival was 8.3% and 73.7%, respectively.

The histology groups range from the very broad (e.g., ‘carcinomas’) to specific histological types and subtypes (e.g., ‘adenosquamous carcinoma’). The data can be stratified by sex and age group and can be downloaded for free. The sites/types currently available are bladder, brain, breast, colorectum, gynaecological, haematological, kidney, liver, lung, cutaneous melanoma, mesothelioma, pancreas, prostate and thyroid. More sites will be added over time.

369 | Cancer survivors’ health behaviour patterns and the relationship with health status and healthcare utilisation

Katia E. Ferrar^1,2, Lisa Beatty³, Tony Daly^4,5, Jennifer Baldock^4,5, Rebecca Scupham^4,5, Liz Buckley¹, Huah Shin Ng¹, Emma Kemp¹, Bogda Koczwara^6,7, Ryan Calabro^4,5

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

²University of South Australia, Adelaide, South Australia, Australia

³College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia

⁴Behavioural Research and Evaluation Unit, Cancer Council SA, Eastwood, South Australia, Australia

⁵Flinders University, Bedford Park, South Australia, Australia

⁶Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia

⁷Flinders Medical Centre, Bedford Park, South Australia, Australia

Aims To explore the relationship between health behaviour patterns and health status and healthcare utilisation of South Australian cancer survivors.

Methods Adult cancer survivor (n = 669) data from the 2023 South Australian Population Health Survey were examined. TwoStep cluster analysis was conducted to identify clusters of health behaviours: meeting guidelines for (1) physical activity (≥150 min moderate to vigorous activity and walking/week), (2) alcohol consumption (<10 drinks/week), (3) dietary intake (≥2 fruit and five vegetable serves/day) and (4) smoking status (yes/no). Relationships between cluster membership and sociodemographic characteristics, self-reported health status and healthcare utilisation (over 12 months) were examined using Chi-square and ANOVA analyses.

Results Six clusters were identified: Cluster 1 (n = 239/669; 36%) was characterised by all members meeting all but the diet guidelines; Cluster 2 (n = 192; 29%) was characterised by meeting smoking and alcohol recommendation but no other guidelines; Cluster 3 (n = 78; 12%) was characterised by meeting smoking and activity recommendations but no other guidelines; Cluster 4 (n = 58; 9%) was characterised by the majority of members meeting alcohol and activity guidelines but no other guidelines; Cluster 5 (n = 57; 9%) was characterised by non-smoking status and not meeting any other guidelines; Cluster 6 (n = 45; 7%) was characterised by majority adherence across the health behaviours. Cluster 2 members were younger (p < 0.001) and had lower education levels (p = 0.02). Clusters 3 and 5 had more males (approx. 70%; p < 0.001). Health status was highest in Cluster 3 and lowest in Cluster 2 (p = 0.01). Health service utilisation was highest in Cluster 4 (M = 26.5, SD = 64.3 visits) and lowest in Cluster 3 (M = 14.7, SD = 13.1) (p = 0.03).

Conclusion Distinct health behaviour clusters and profiles exist among South Australian cancer survivors. These findings may assist risk monitoring, health system planning and the development of multidimensional health behaviour interventions to improve outcomes for cancer survivors.

370 | Menopausal hormone therapy use and future breast cancer risk in the Lifepool cohort: A comparative study adjusting for breast density

Saima Islam^1,2, Louiza Velentzis^1,2, Sabine Deij², Asres Tilahune^1,2, Pietro Procopio^1,2, Carolyn Nickson^1,2

¹The Daffodil Centre, A partnership between Cancer Council and The University of Sydney, Woolloomooloo, NSW, Australia

²Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia

Aim: We report the association between menopausal hormone therapy (MHT) types and incident breast cancer (invasive/DCIS) in ∼20,000 Australian women, after adjusting for breast density and other associated factors.

Methods: Our dataset comprised baseline questionnaires, breast density, screening and cancer registry data for Lifepool cohort participants (mostly from BreastScreen) aged 40–75 without a personal history of breast cancer. We categorised self-reported current MHT formulations as: EPT (oestrogen and progestogen combinations); ET (oestrogen-only); T (tibolone) or PT/LET (progestogen/progesterone only preparations/other estrogen-only creams and pessaries). The primary outcome was incident breast cancer. We fitted multivariate Cox regression models adjusted for baseline breast density, age, age at first period, parity, breastfeeding, body mass index, region of birth, smoking status and strong family history. We excluded records with inadequate MHT information and applied multiple imputation for missing covariate data. Missing data ranged from 1.1% to 5.8% across covariates.

Results: 19,545 participants were included in the analysis, with baseline questionnaires completed between 06 March 2010 and 12 April 2015. There was total 518 (2.7%) incident breast cancers, with a mean follow-up of 7.1 years (range: 61 days–9.6 years). 19.7% of the study group were current users of MHT at baseline (4.1% EPT, 11.2% ET, 3.4% T and 1.0% SPT/LET). In the fully adjusted model, compared to never users of MHT, current users had a significantly higher risk of developing breast cancer (HR = 1.4 (95%CI 1.2–1.8), p < 0.001). This held for most types assessed: EPT HR = 1.7 (95%CI 1.2–2.5), p = 0.01; ET HR = 1.4 (95%CI 1.1–1.7), p = 0.02; and T HR = 1.7 (95%CI 1.2–2.5), p = 0.01.

Conclusions: Various types of MHT significantly increase breast cancer risk after accounting for breast density and other factors. This included combined oestrogen and progestogen, oestrogen-only and tibolone. MHT use continues to be an important risk factor for breast cancer and should be considered in recommendations for breast cancer prevention.

371 | Assessment and stratification of cardiovascular disease risk in people diagnosed with breast cancer: A scoping review

Mihye Jeon¹, Tracey DiSipio¹, Gail Garvey¹, Louise Wilson¹, Abbey Diaz^1,2

¹School of Public Health, University of Queensland, Herston, QLD, Australia

²College of Health and Medicine, Australian National University, Canberra, ACT, Australia

Background: Breast cancer (BC) patients are at increased risk of cardiovascular disease (CVD), largely due to cardiotoxic cancer treatments^1,2 and pre-existing risk factors, such as hypertension, diabetes, tobacco smoking and low physical activity.^3,4 Several measures/tools have been suggested or used in research to determine baseline risk and appropriate CVD care during and beyond cancer treatment. This review aims to scope the literature to identify baseline (pre-treatment) CVD risk assessment tools/measures for BC patients proposed, developed, validated, or used in research.

Methods: PubMed, Embase and Google Scholar were searched for articles published January 2013–March 2024, using relevant terms. Eligibility was assessed and key data extracted from included articles independently by two reviewers. Publications included research articles (observational and experimental studies), position/policy, commentary and review papers that addressed the scoping review aim.

Results: 142 articles were included; 56% research articles. Thirteen tools assessed risk of CVD broadly (n = 3), specifically cardiotoxicity or heart failure (n = 8), venous thromboembolism (n = 1) or CVD death (n = 1) in people with BC. Four tools went through validation and performed poor to moderate in stratifying BC patients into correct risk categories. All tools included age as a risk factor; other common risk factors were type of BC treatment and pre-existing hypertension and CVD. While clinical guidance and recommendations were identified, these were either for cancer patients broadly or for specific treatment types, rather than specifically for people diagnosed with BC.

Conclusion: This scoping review identified a number of existing tools/measures with common risk factors but which performed poorly in correctly stratifying BC patients into risk categories. Further work is needed to optimise the effectiveness of baseline CVD risk assessments for monitoring BC patients during and beyond treatment to improve CVD health and outcomes.

372 | Effects of perioperative exercise therapy (aerobic, resistance, pelvic floor, mind-body exercise, or mixed exercise (combined aerobic and resistance) on quality of life and adverse events in prostate cancer patients undergoing surgery: A PRISMA compliant systematic review and meta-analysis of randomised controlled trials (RCTs)

Nazib Khan¹

¹La Trobe Regional Health, Traralgon, VIC, Australia

Aims: A radical prostatectomy (RP) is the most common treatment for localized prostate cancer, which has a 15-year survival rate approaching 90%. Exercise can improve quality of life and fatigue in cancer survivors. It has been shown that perioperative exercise can predict post-surgery outcomes. An objective of this review was to determine if perioperative exercise therapy (aerobic, mind-body, pelvic floor, resistance, or combination thereof) improved prostate cancer-specific quality of life, as well as the adverse effects of prostate cancer surgery on patients with prostate cancer.

Methods: Between March 1980 and December 2022, a systematic search of exercise intervention trials with prostate cancer patients was conducted in English. Databases included PubMed, CINHAL, Web of Sciences, SPORTS Discus, and Cochrane Library. Medical Subject Headings (MeSH) terms were used. The intervention group consisted of randomized controlled trials with aerobic, resistance, pelvic floor, mind-body, and mixed exercises (combined aerobic and resistance) as interventions, and the control group consisted of no interventions or standard care.

Results: Thirty-one of the 1162 retrieved studies were included in the systematic review, and 15 articles were included in the meta-analysis. A total of 1971 prostate cancer patients (1018 intervention and 953 control) were included in the meta-analysis with radical prostatectomy. Pooled evidence from randomised controlled trials (n = 1971 participants) identifies that perioperative exercise therapy (aerobic, resistance, pelvic floor, mind-body exercise, or mixed exercise (combined aerobic and resistance) has a positive impact on patient quality of life and adverse events in PCa patients undergoing surgery which is predominant in perceptions of symptom related QoL (SMD: 0.56, 95% CI's [0.22–0.89]) more so than health-related quality of life (HRQoL) (SMD: 0.02, 95% CI's [−0.16 to 0.20]; 3)

Conclusions: Combined evidence from RCTs shows improvement in QOL. These results support the hypothesis that exercise interventions improve prostate cancer-specific quality of life.

373 | Disparities in rare cancer incidence – Comparative results from a population-based data analysis in Queensland

Ming M.L. Li¹, Shafkat S.J. Jahan¹, Vanda V.N. Nissan¹, Sewunet S.B. Belachew¹, Habtamu H.B. Bizuayahu¹, Gail G.G. Garvey¹

¹University of Queensland, Herston, QLD, Australia

Aims: Rare cancers in Australia are less reported in Australia, and it does not account for Indigenous status. We compared the incidence of rare cancers by Indigenous and socioeconomic status in Queensland.

Methods: This is a population-based study among adults aged 18+ with cancer diagnosis recorded in Queensland Cancer Registry during 2012–2015. Ten malignancies from Cancer Council Australia, were listed using the WHO ICD-O-3 histology and typology codes: Adenoid cystic carcinoma, Appendix, ocular Melanoma, gallbladder, neuroendocrine, penile, pseudomyxoma, small bowel, soft tissue sarcoma, ureter. Both individual characteristics including age, sex, country of birth, marital status, occupation, and area-level residential remoteness and socioeconomic disadvantage status were included. The trend of rare cancers incidence and those from digestive and urinary tract during 2012–2015 were compared by Indigenous status. Disparity by Indigenous status, individual and area-level socioeconomic factors were investigated with logistic regression analysis.

Results: A total of 105,328 adults with known ethnicity (99.4%) were diagnosed with cancers in Queensland during 2012–2015. 5160 (4.9%) had rare cancers, with the most frequent being malignancies from appendix (n = 1681,1.6%), followed by soft-tissue sarcoma (n = 1360, 1.2%), neuroendocrine (n = 580, 0.6%), and small bowel (n = 573, 0.5%). Rare cancer incidence increased among First Nations populations, but not in other Queenslanders, particularly those from tracts. First Nations people were 13% (aOR 1.13, 95% CI 1.08–1.59) more likely to have rare cancers, even high for those from tracts (aOR 1.55, 95% CI 1.22–1.99), after adjusted for other individual and area-level factors. Regional area had registered fewer rare cancers compared to metropolitan areas by 14% (aOR 0.86, 95% CI 0.79–0.95).

Conclusions: Rare cancers diagnosis, especially those from digestive and urinary tracts, increased in First Nations populations in 2012–2015. Rare cancer awareness is needed in the First Nations communities, especially among the higher risk subgroups.

374 | Real-world usage patterns of palbociclib and associated patient characteristics in Australia: A retrospective analysis

Richard H. De Boer¹, Louise Nott², Maree Colosimo³, Eugene Moylan⁴, Giles W.P. Stratton⁵, Thomas W. Chiu⁵, Mahsa H. Kouhkamari⁶, Maureen Hitschfeld⁶, Jessica Michie⁵

¹St Vincent's Private Hospital, Melbourne, Australia

²Icon Cancer Centre, Hobart, Australia

³St Vincent's Private Hospital Northside, Brisbane, Australia

⁴Liverpool Hospital, Liverpool, UK

⁵Pfizer, Australia and New Zealand

⁶IQVIA, Australia

Objectives: This study sought to understand the real-world use of palbociclib in HR+/HER2- advanced or metastatic breast cancer in Australia. The primary objective was to describe the demographic and clinical characteristics of patients initiating Pharmaceutical Benefits Scheme (PBS) funded palbociclib, including age, sex and baseline comorbidity burden. Secondary objectives included evaluating real-world usage and outcomes with palbociclib, including initiation dose and modifications, time to chemotherapy initiation, persistence, and subsequent use of PBS reimbursed anti-cancer medications post-discontinuation.

Method: This non-interventional retrospective cohort study utilised the PBS10% dataset, which includes longitudinal claims data from January 2004 to December 2023. The study population comprised CDK4/6i-naïve patients aged ≥18 years who initiated treatment with PBS funded palbociclib. Comorbidities were determined using the validated Rx-Risk Comorbidity Index. Descriptive data analyses were conducted, and Kaplan–Meier method was used for time-to event analysis.

Results: The study analysed data from 407 patients initiating palbociclib. Analyses identified that the median age at palbociclib initiation was 67 years, 67% were >60 years old at initiation. 67% of patients received treatment for ≥3 comorbidities in the preceding 12 months. 80% of patients started on 125 mg formulation and 53% of patients did not experience a dose modification (all initiated doses). At a median follow-up of 38 months, 61% and 40% remained on treatment at 12 and 24 months, the median time on palbociclib was 541 days (∼18 mo). Median time to chemotherapy was not reached. Of the patients who discontinued palbociclib during the study period, 82.6% commenced other PBS reimbursed anti-cancer medications within 180 days. Subsequent therapies included aromatase inhibitors (54%), fulvestrant (12.9%), everolimus (5.3%) and chemotherapy (54.5%) including capecitabine (32%) and nab-paclitaxel (18.7%).

Conclusion: This study provides real-world data on the utilisation and outcomes on palbociclib in Australia, offering insights into the management of HR+/HER2- advanced or metastatic breast cancer.

375 | Advancements and opportunities in clinical trial data sharing: A review of CSR and IPD accessibility for oncology trials

Natansh D. Modi¹, Michael J. Sorich¹, Ashley M. Hopkins¹

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

Background: The transparency of clinical trial data, specifically Clinical Study Reports (CSRs) and Individual Participant Data (IPD), is essential for building trust in drug approval processes, preventing study duplications, and informing future trials. Organizations such as the World Health Organization, Cochrane, and the European Medicines Agency advocate for independent access to these data to enhance scientific discovery and clinical practice.

Methods: A comprehensive review was conducted to evaluate recent policy changes, current status, and future opportunities for CSR and IPD sharing, with a focus on industry-sponsored oncology trials. We analysed published cross-sectional studies that examined trials cited in FDA-approved drug labels. Additionally, we reviewed current policies of major pharmaceutical companies and regulatory agencies regarding CSR and IPD sharing.

Results: Policy changes by the EMA and Health Canada have facilitated the sharing of CSRs, yet operational challenges remain. Analysis of cross-sectional studies revealed that 35% of CSRs were publicly accessible through regulatory portals and 21% were available upon request from sponsors. 44% of CSRs remain inaccessible. For IPD, 45% of trials were eligible for data requests, but data was provided for only 77% of eligible trials. The median time to data provision was 123 days, with significant variability in data completeness. Overall, IPD was acquired from only 34% of trials – highlighting the risk of bias in systematic reviews relying on limited data.

Recommendations: To address these challenges, it is recommended to standardize CSR and IPD sharing policies, ensure immediate data availability upon drug approval, and employ independent panels for IPD request reviews. Comprehensive data sharing can facilitate practice-changing findings, improve systematic reviews, and enhance personalized patient care. Stakeholders, including regulatory bodies, journals, and the pharmaceutical industry, must collaborate to implement policies that promote transparency and maximize the potential for scientific discovery.

376 | A chat-tastrophe: Cross-sectional evaluation of customisable cancer GPTs accessible via OpenAI's ChatGPT platform

Bianca B. Chu¹, Bradley D. Menz¹, Natansh D. Modi¹, Michael J. Sorich¹, Ashley M. Hopkins¹

¹Flinders University – College of Medicine and Public Health, Seaton, SA, Australia

Objectives: In May 2024, OpenAI enabled public access to a novel feature of ChatGPT, called ‘GPTs’, a customisable and task-specific version of ChatGPT. While these GPTs have potential to support patient education, their ease of creation and public availability raise concerns on their accuracy and safety. Therefore, this study aimed to evaluate the GPTs currently available to patients and clinicians for cancer-specific applications, focusing on their intended use, usage frequency and endorsement by regulatory or professional organizations.

Methods: OpenAI's GPT store was accessed within the ChatGPT platform, and a search of the available cancer-specific GPTs was conducted using the terms ‘oncology’, ‘cancer’, ‘chemotherapy’, ‘lung cancer’, ‘breast cancer’, ‘bowel cancer’ and ‘colorectal cancer’. Two researchers reviewed the descriptions provided by the GPT creators to determine their intended use, the number of conversations (i.e., individual uses), and whether the GPTs were endorsed by any regulatory or professional organizations. Identified GPTs were then classified into two categories: patient-specific tools or clinician-specific tools, and results were presented using descriptive statistics.

Results: In August 2024, a total of 202 cancer-specific GPTs were identified. This included 98 (49%) patient-specific and 104 (51%) clinician-specific tools. A cumulative total of over 5000 conversations with these GPTs were recorded, with two GPTs having over 500 conversations each. Importantly, none of the identified cancer-specific GPTs had endorsements or verifications from regulatory or professional organizations regarding the accuracy of the medical information they provide.

Conclusions: This study highlights the growing proliferation of unregulated and publicly accessible GPT models designed to provide cancer-related information to both patients and clinicians. While they have the potential to offer valuable supplementary support, their ease of creation and the risk of disseminating unverified health information highlight the need for further evaluation and regulatory intervention.

377 | Effect of metabolic factors on the risk of precancerous polyps among people undergoing surveillance colonoscopy: A systematic review and meta-analysis

Meseret Molla¹, Erin Symonds¹, Jean Winter¹, Zegeye Abebe¹, Molla Wassie¹

¹Flinders Medical Research Institute, Colloge of Medicine and Public Health, Flinders University, Adeliade, SA, Australia

Aim: The association between metabolic factors and precancerous polyps in individuals undergoing surveillance colonoscopies is unclear. We aimed to systematically summarise existing literature on the effect of various metabolic factors on the risk of precancerous polyps among these individuals.

Methods: We searched seven databases (Medline/Ovid, Cochrane Library, Web of Science, CINHAL, Scopus, PsycINFO, ProQuest) for studies published from 2010 to 2023. Eligible studies included cohorts undergoing surveillance colonoscopy due to a family history of colorectal cancer (CRC), or a personal history of precancerous polyps or CRC. Exposure variables included at least one metabolic factor (obesity, diabetes mellitus, hypertension, or dyslipidemia). Two independent reviewers performed article screening, data extraction, and quality assessment. The association between metabolic factors and risk of precancerous polyps was assessed using a random effect meta-analysis of pooled odds ratio (POR) or pooled hazard ratio (PHR). Heterogeneity was assessed as high when I² was >50%.

Results: 24 studies were eligible. General obesity (14 studies; POR = 1.31, 95% CI 1.09; 1.57, I² = 67%), central obesity (three studies; POR = 1.31, 95%CI 1.16; 1.49, I² = 0%), hypertension (13 studies; POR = 1.22, 95%CI 1.02; 1.44, I² = 57%), high triglyceride (two studies; POR = 1.39, 95%CI 1.06; 1.83, I² = 0%), and metabolic syndrome (three studies; PHR = 1.24, 95%CI 1.01; 1.51, I² = 24%) were found to be a significant risk factor for precancerous polyps. For advanced precancerous polyps (tubular adenoma or sessile serrated lesions ≥10 mm in size or villous features ± high-grade dysplasia, or any size traditional serrated adenoma), only general obesity and diabetes were eligible to assess by meta-analysis, where obesity (three studies; PHR = 3.04, 95%CI 2.01; 4.60, I² = 0%) but not diabetes (three studies; PHR = 1.07, 95%CI 0.72; 1.57, I² = 0%) was significantly associated with the risk of advanced precancerous polyps.

Conclusions: Most metabolic factors were associated with precancerous polyps. Considering metabolic conditions for determining surveillance colonoscopy frequency could improve the effectiveness of CRC prevention strategies.

378 | Patient-reported outcomes after prostate cancer treatment: Findings from the ACT prostate cancer outcomes registry (PCOR-ACT)

Michael Odutola¹, Elizabeth Denham¹, Mirka Smith¹, Elizabeth Chalker¹, Marcus Nicol¹

¹Data Analytics Branch, ACT Health Directorate, Canberra, ACT, Australia

Introduction: Prostate cancer is the most common cancer among males in Australia and the ACT, accounting for 28.1% of all newly diagnosed cases.

Objectives: To evaluate patient-reported outcomes 12 months after diagnosis or treatment among individuals enrolled in the PCOR-ACT between 2015 and 2021.

Methods: We collected patient-reported outcomes measure (PROMs) data assessing quality-of-life 12 months after curative-intent treatment (for participants who received surgery, radiotherapy, brachytherapy, or gland ablation) or 12 months after diagnosis (for participants on active surveillance or watchful waiting, or other therapies). We used the expanded prostate cancer index composite-26 survey to examine outcomes in three domains (urinary, bowel and sexual).

Results: A total of 2025 individuals were eligible for 12-month follow-up and of these, 1489 (74%) completed the PROMs. One-quarter of all PROMs were completed by men in the 65–69 year age-group. Common clinical management approaches of individuals who completed PROMs were prostatectomy (53%), active surveillance/watchful waiting (18%), combined radiation therapy and androgen-deprivation therapy (14%), androgen-deprivation therapy (7%), radiation therapy (6%) and others (2%). Moderate/big urinary bother was reported by 12% of participants and of these, almost half had received a prostatectomy (47%). About 5% of participants reported moderate/big bowel bother and of these, one-third were treated with combined radiation therapy and androgen-deprivation therapy. Moderate/big sexual bother was reported in 32% of participants and of these, two-thirds had received a prostatectomy. Overall, two out of five participants reported moderate/big bother in at least one of the domains.

Conclusion: Of the three domains, sexual function appears to be most adversely affected in PCOR-ACT participants, and this was more common among those who had prostatectomy.

379 | Descriptive and clinical characteristics of multiple malignancies in patients with lung cancer

Laura S. Park^1,2,3, Bridget Josephs¹, Hieu Chau¹, Mahesh Iddawela^1,2,3, Quan Tran^1,3, Cassandra Moore¹, Tricia Wright¹, Evangeline Samuel^1,2,3,4

¹Gippsland Cancer Care Services, Latrobe Regional Health, Traralgon, Victoria, Australia

²Monash Rural Health Gippsland, Monash University, Traralgon, Victoria, Australia

³Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia

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

Background: As cancer survival rates improve, reports of multiple primary malignancies are increasing. Lung cancer remains a leading cause of cancer incidence and mortality, but data on patients with multiple malignancies are limited. This study compared the demographic and clinical characteristics of lung cancer patients with multiple malignancies to those with a single primary malignancy in Gippsland, Victoria.

Methods: Demographic and clinicopathological data were retrospectively collected from 584 lung cancer patients in the Gippsland lung cancer database at Latrobe Regional Health from 2019 to 2023. Summary statistics described age, sex, smoking status, ECOG status, cancer stage and histology, and survival. For patients with multiple malignancies, the time between each diagnosis was calculated.

Results: Data for 448 patients were analysed; 89 (19.9%) patients had multiple malignancies. The most common additional malignancy was breast cancer (21.3%), followed by non-melanoma skin cancer (19.1%) and colorectal cancer (15.7%). The median time between initial and lung malignancy diagnosis was 6.5 years (range 0–37 years). Lung adenocarcinoma was the most common type of lung cancer in both multiple and single malignancy groups (48.3% and 46.8% respectively). Age, sex and smoking status were similar across groups. A higher percentage of Stage I-II lung cancer was observed in the multiple malignancy (43.8%) compared to lung cancer only (32.9%) group. A higher mortality rate was seen in the single than the multiple malignancy group (52.6% and 48.2%, respectively).

Conclusions: Patients with lung cancer following a prior malignancy had a higher proportion of potentially curable early-stage lung cancer and fewer deaths compared to those with a single lung cancer diagnosis. This suggests that surveillance and healthcare system integration may improve early detection of secondary malignancies and impact survival. Further prospective studies of cancer registries including secondary cancers are warranted.

380 | The relationship between lower-limb lymphoedema and anxiety, depression, quality of life and overall survival post-gynaecological cancer

Melanie L. Plinsinga¹, Monika Janda², Hildegard Reul-Hirche¹, Dimitrios Vagenas³, Andreas Obermair⁴, Kira Bloomquist¹, Sandi Hayes⁵

¹School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia

²Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia

³School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia

⁴Queensland Centre for Gynaecological Cancer Research, The University of Queensland, St Lucia, QLD, Australia

⁵Cancer Council Queensland, Fortitude Valley, QLD, Australia

Aims: To (1) establish cumulative burden of lower-limb lymphoedema, and (2) determine the relationship between lower-limb lymphoedema and anxiety, depression, quality of life and overall survival following gynaecological cancer.

Methods: Data from the LEG study, which is a prospective, longitudinal, cohort study including 408 women with gynaecological cancer, contributed to analyses. Outcomes of interest were assessed at baseline (pre-definitive diagnosis of gynaecological cancer) and at 6 weeks to 3 months, 6 months to 12 months and 15–24 months post-surgery. Linear regression analyses were undertaken to assess associations between cumulative burden of lower-limb lymphoedema (any evidence of lower-limb swelling within the first 24 months post-surgery) and anxiety and depression (measured via the Hospital Anxiety and Depression Scale) and quality of life (measured via the Functional Assessment of Cancer Therapy-General) assessed at 24 months post-surgery. Logistic regression was used to assess the relationship between cumulative burden of lower-limb lymphoedema and overall survival at 5-years follow up. Results were described using means (SD) and n (%), and p < 0.05 was considered statistically significant.

Results: The cumulative incidence of lymphoedema was 37% and 45% by 24 months post-diagnosis, when measured objectively and via self-report, respectively. Those with self-reported lymphoedema reported higher anxiety and depression scores and lower quality of life when compared with those who did not report leg swelling (differences were clinically relevant; p < 0.05), but these relationships were not seen for objectively-measured lymphoedema. Overall survival at 5-year follow up did not differ between groups for self-reported lymphoedema (those with evidence of swelling: 30% deaths; no evidence of swelling: 36% deaths; p = 0.34), but when lower-limb lymphoedema was objectively measured, those with lymphoedema had a 1.6 higher hazard of death compared to those without (HR: 1.6, 95%CI: 0.80–3.39).

Conclusions: These findings demonstrate the impact of swelling on health outcomes and potentially survival.

381 | Senescence-based AI predicts risk of malignancy in biopsy images of benign breast disease

Indra Heckenbach¹, Rita Peila², Christopher Benz³, Sheila Weinmann⁴, Yihong Wang⁵, Mark Powell³, Morten Scheibye-Knudsen¹, Tom Rohan²

¹Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark

²Albert Einstein College of Medicine, Bronx, NEW YORK, USA

³Buck Institute for Research on Aging, Novato, California, USA

⁴Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA

⁵Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island, USA

Background: Most breast biopsies are negative for malignancy but may still indicate elevated risk of invasive breast cancer (IBC) due to the presence of benign breast disease (BBD). Cellular senescence plays a complex but poorly understood role in breast cancer development. Deep learning methods offer a novel approach to predict senescence from biopsy images, potentially enhancing our ability to predict IBC risk in women with BBD.

Methods: We conducted a case-control study, nested within a cohort of 15,395 women biopsied for BBD at Kaiser Permanente Northwest between 1971 and 2006. Cases (n = 512) were women who developed a subsequent IBC ≥ 1 year after the BBD biopsy; controls (n = 491) did not develop IBC during the same follow-up period. Using H&E-stained biopsy images, we predicted senescence based on deep learning models trained on replicative senescence (RS), ionizing radiation (IR), and various drug treatments. Age-adjusted and multivariable odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression.

Results: The RS- and IR-derived senescence scores in adipose tissue and the RS-derived score for epithelial tissue were positively associated with risk of IBC (adipose tissue – RS model: OR_q4 vs. _q1 = 1.69, 95% CI 1.03–2.77, and IR model: OR_q4 vs. _q1 = 1.73, 95%CI 1.06–2.82; epithelial tissue – RS model: OR_{q4 vs. q1} = 1.53, 95% CI 1.05–2.22). The results were stronger among postmenopausal women and women with epithelial hyperplasia with/without atypia. There was increased risk of IBC in those with higher senescence scores in both epithelial and adipose tissue compared with those with low senescence scores in both (IR epithelium-IR fat: OR_{q2-4 vs. q1} = 2.14, 95% CI 1.30–3.51; IR epithelium-RS fat: OR_{q2-4 vs. q1} = 2.24, 95% CI 1.15–4.35).

Conclusion: Nuclear senescence scores predicted by deep learning models in breast epithelial and adipose tissue were positively associated with the risk of IBC among women with BBD.

382 | Cardioprotective medications and the incidence of cardiovascular events in patients treated with radiotherapy: A systematic review and meta-analysis

Vishwa Pakeerathan^1,2, Rav Marwah^3,4, Abdul Rahman Mohammed^3,4, Justin Smith^1,2

¹University of Queensland, Brisbane, QLD, Australia

²Princess Alexandra Hospital, Brisbane, QLD, Australia

³Townsville University Hospital, Townsville, QLD, Australia

⁴College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

Background: Radiotherapy (RT) has been shown to increase the risk of cardiovascular and cerebrovascular disease through mechanisms such as accelerated atherosclerosis. However, limited studies have focused on the effects of cardioprotective medications and their impacts on reducing CVD burden in patients treated with RT.

Methods: A literature search of PubMed, Embase and Scopus was performed in May 2024. Studies of adult patients treated with RT to the head and neck or mediastinum investigating the effect of cardioprotective medications (anti-hypertensives, lipid-lowering therapies or anti-thrombotic medications) on the incidence of cardiovascular events were eligible for inclusion. Studies that reported the prevalence of patients at high risk of cardiovascular disease using cardioprotective medications were also included.

Results: There were nine studies which met eligibility for inclusion. Meta-analysis of three studies suggested that patients treated with RT to the head and neck region who received statin therapy had a reduced risk of cerebrovascular events, with a relative risk of 0.77 (95% CI 0.66–0.90). Only two studies investigated statin use in patients receiving radiotherapy to the mediastinum with both finding no difference in CVD events between the statin and non-statin groups. Four studies investigated the prevalence of cardioprotective medication use in patients treated with RT, with a significant proportion (38%–88%) of patients with indications for lipid lowering therapy not currently prescribed these medications.

Conclusion: Statin therapy may be associated with a reduction in stroke for patients with head and neck cancer treated with RT. Clinicians involved in the care of patients treated with RT to the head and neck or mediastinum should be aware of the increased CVD risk and consider appropriate prescription of cardioprotective medications. Further research is required to prospectively evaluate the role of cardioprotective medications in the prevention of CVD in patients treated with RT.

383 | Long-acting, progestin-based contraceptives and risk of breast, gynaecological and other cancers

Karen Tuesley^1,2, Katrina Spilsbury³, Sallie Pearson^4,5, Peter Donovan^6,7, Andreas Obermair^8,9, Michael Coory¹⁰, Sitwat Ali^1,2, Nirmala Pandeya^1,2, Louise Stewart¹¹, Susan Jordan^1,2, Penelope Webb^1,2

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

²Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

³Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia

⁴Centre for Big Data Research in Health, The University of New South Wales, Sydney, NSW, Australia

⁵School of Population Health, University of New South Wales, Sydney, NSW, Australia

⁶Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

⁷Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

⁸Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

⁹Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia

¹⁰Mater Research Institute, University Of Queensland, Brisbane, QLD, Australia

¹¹School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia

Background: Use of long-acting, reversible contraceptives (LARCs) has increased substantially over the last 20 years, however there is limited understanding on how these might influence cancer risk.

Methods: We conducted a nested case-control study among a national cohort of Australian women (176,601 women with a first cancer diagnosis 2004–2013 and 882,999 matched controls) to investigate the associations between the levonorgestrel intrauterine system (LNG-IUS), etonogestrel implants (ENG-IMP) and depot-medroxyprogesterone acetate (DMPA) and cancer risk and compared these results to the oral contraceptive pill (OCP). We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI).

Results: Compared to never users, use of LNG-IUS, ENG-IMP and DMPA was associated with increased cancer risk. For LNG-IUS and DMPA this persisted among former users, while for ENG-IMP the risk returned to baseline after cessation, similar to the oral contraceptive pill (OCP). LNG-IUS and ENG-IMP use was associated with increased breast cancer risk (OR = 1·26, 95%CI: 1·21–1·31 and OR = 1·24, 95%CI: 1·17–1·32, respectively), but not DMPA except when used for 5 or more years (OR = 1·23, 95%CI: 0·95–1·59). Use of LNG-IUS (1+ years) was associated with reduced risks of endometrial (OR = 0·80, 95%CI: 0·65–0·99), ovarian (OR = 0·71, 95%CI: 0·57–0·88) and cervical cancers (OR = 0·62, 95%CI: 0·51–0·75). ENG-IMP and DMPA were associated with reduced risk of endometrial (OR = 0·21, 95%CI: 0·13–0·34; OR = 0·52, 95%CI: 0·32–0·84) and, less strongly, ovarian cancer (OR = 0·76, 95%CI: 0·57–1·02; OR = 0·82, 95%CI: 0·54–1·25).

Conclusion: LARCs have similar cancer associations to the OCP (reduced endometrial and ovarian cancer risks and short-term increased breast cancer risk). Women should be advised of this when choosing a form of contraception.

384 | Association of the G8 score and commencing systemic treatment in older adults with cancer in an Australian Regional Cancer Centre

Paul Viray¹

¹Medical Oncology, Austin Health/Latrobe Regional Hospital, Melbourne, VIC, Australia

Aim: The Geriatric-8 (G8) Screening Tool has been validated to screen patients for clinical frailty and who would benefit from a Comprehensive Geriatric Assessment (CGA).¹ A G8 score of 15+ implies one is fit, unlikely to need a CGA, and should receive standard of care treatment. Whereas, a score of <15 implies a patient is frail and should undergo a CGA with subsequent management determined by CGA recommendations. Its association with mortality and clinical outcomes has not been studied in an Australian population.

Methods: This single centre retrospective cohort study examined patients in a regional cancer centre aged 65+ commencing intravenous systemic anticancer treatment from 1 January 2021 to 31 December 2021 with information collected up until 30 June 2023 for outcomes and analysis. The G8 score was applied retrospectively to their status prior to C1D1 of treatment using all available data from the electronic medical record.

Results: A sample size of 173 patients was analysed after applying inclusion and exclusion criteria. Median age was 73 (range 65–88), 41% had a G8 score 15+, 59% had G8 score <15. The most common cancer types were Lung (26%), breast (13%), and colorectal cancer (10%). Kaplan–Meier Curves revealed improved survival if G8 score 15+ with a hazard ratio of 0.36 (95% CI 0.22–0.59, p < 0.001). The 1 year mortality for a G8 score of 15+ was 18% versus 48% if G8 score <15. Completion of planned treatment without dose reductions or delays was 62% if G8 score 15+ versus only 24% if G8 < 15.

Conclusion: The G8 score is an important tool in geriatric oncology for predicting mortality if systemic treatment is to be given, as well as predicting the ability for patients to complete systemic treatment without dose reductions or delays.

Reference:

1. Bellera CA et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012; 23(8):2166-2172.

386 | Case report: Adult onset medulloblastoma – SHH activation with abnormal P53 expression

Tremayne Bauer¹, Poh See Choo²

¹Ramsay Pharmacy – Greenslopes Private Hospital, Greenslopes, QLD, Australia

²Medical Oncology, Greenslopes Private Hospital, Greenslopes, QLD, Australia

Background: Medulloblastoma is a rare embryonal tumour of the cerebellum with an estimated incidence of 0.5 cases per million per year in adults. Patient age and presence of metastases at diagnosis, histological variant, molecular sub-grouping and treatment related sequalae lead to varying survival and quality of life outcomes.

Case Presentation: A 39-year-old male presented to his GP with progressively worsening occurrences of morning dizzy spells, nausea and vomiting, lethargy and increasing unsteadiness. He is married with two children. He has no other comorbidities or significant medical history.

Investigations: Magnetic resonance imaging reported a large solid and cystic 4th ventricle mass measuring 37 × 33 × 37 mm with surrounding vasogenic oedema in the right cerebellar hemisphere. Histopathology reported a grade 4 medulloblastoma of desmoplastic/nodular sub-type with focal severe anaplasia. Immunohistochemistry confirms SHH pathway activated disease with abnormal p53 expression indicating possible TP53-mutation. Whole spine magnetic resonance imaging showed generalized superficial chord involvement diffusely with larger deposits posteriorly at C6/7 and subtle deposits in the cauda equina region. Cerebrospinal fluid examination showed atypical cells.

Treatment: Maximal tumour resection was followed by craniospinal radiation with a radiation boost to the tumour bed, posterior fossa and leptomeningeal spread sites. High dose chemotherapy using St Jude hospital SJMB-12 protocol containing cisplatin, vincristine and cyclophosphamide was administered through four cycles. A dose intense regimen with stem cell rescue was utilized, with metastases at diagnosis and likely TP53 mutation indicating high relapse risk. Targeted maintenance therapy was employed through use of the SHH pathway inhibitor sonidegib.

Discussion: Targeted therapy is a promising treatment option for SHH-activated medulloblastoma however drug access is limited due to cost and availability. Tumour rarity and disease heterogeneity has limited clinical trial utilization to define optimal therapy. Recent imaging has shown disease resolution with no signs of tumour recurrence for this patient.

387 | Immune checkpoint inhibitors ± chemotherapy for patients with NSCLC and BM: A systematic review and network meta-analysis

Lauren Julia Brown^1,2,3,4, Nicholas Yeo⁵, Harriet Gee^4,6, Ines Pires da Silva^2,3,7, Ben Y. Kong^5,8, Eric Hau^3,4,6, Adnan Nagrial^2,3,9

¹Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia

²Department of Medical Oncology, Blacktown Hospital, Blacktown, Australia

³University of Sydney, Camperdown, NSW, Australia

⁴Radiation Biology and Translational Oncology Group, Westmead Institute for Medical Research, Westmead, NSW, Australia

⁵Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia

⁶Sydney West Radiation Oncology Network (SWRON), Westmead Hospital, Westmead, NSW, Australia

⁷Melanoma Institute Australia, Wollstonecraft, NSW, Australia

⁸SPHERE Cancer Clinical Academic Group, University of New South Wales, Sydney, NSW, Australia

⁹Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia

Background: Data regarding immunotherapy efficacy for patients with metastatic NSCLC and brain metastases (BM) are limited and represent a small subset of the clinical trial population. Phase II studies have demonstrated intracranial efficacy of immune-checkpoint inhibitors (ICI) ± chemotherapy.^1–3 The efficacy of chemotherapy and ICI combinations compared to ICI alone in patients with metastatic NSCLC with BM remains unknown.

Methods: A systematic review and network meta-analysis were performed (PROSPERO-CRD42024501345). The objective of this study was to evaluate ICI efficacy in metastatic NSCLC and BM and the influence of additional chemotherapy on survival outcomes. Randomised phase II/III studies with at least one treatment arm with an ICI were eligible for inclusion. The target population was treatment-naïve metastatic NSCLC. Efficacy results including OS and PFS in the subpopulation of patients with and without BM were assessed.

Results: Ten studies were included, totalling 6560 patients, of whom 770 had BM. Pairwise meta-analysis revealed that patients with BM treated with ICI ± chemotherapy had improved PFS (HR 0.49; 95% CI 0.39–0.60) and OS (HR 0.55; 95%CI 0.44–0.68) versus chemotherapy alone. Patients without BM treated with ICI ± chemotherapy also improved PFS (HR 0.60; 95% CI 0.52–0.68) and OS (HR 0.72; 95% CI 0.66–0.78).

In the network meta-analysis of patients with BM, combination ICI with chemotherapy demonstrated improved PFS compared to ICI alone (HR 0.64; 95% CI 0.43–0.96; p = 0.03). However, no significant difference was observed in OS between the two treatments (HR 0.99; 95% CI 0.56–1.74; p = 0.97). Conversely, in the population of patients without BM, no significant differences in either PFS (HR 1.09; 95% CI 0.82–1.44; p = 0.56) or OS (HR 0.99; 95% 0.81–1.20; p = 0.92) were observed between ICI and chemotherapy group versus ICI alone.

Conclusion: Combination chemoimmunotherapy offers PFS benefit over ICI in BM patients, warranting direct comparisons in clinical trials.

References:

1. Goldberg SB, Schalper KA, Gettinger SN, et al., Pembrolizumab for management of patients with NSCLC and brain metastases: long-term results and biomarker analysis from a non-randomised, open-label, phase 2 trial. Lancet Oncol. 2020;21(5):655-663. doi: 10.1016/s1470-2045(20)30111-x.

2. Hou X, Zhou C, Wu G, et al., Efficacy, safety, and health-related quality of life with camrelizumab plus pemetrexed and carboplatin as first-line treatment for advanced nonsquamous NSCLC with brain metastases (CAP-BRAIN): A multicenter, open-label, single-arm, phase 2 study. J Thor Oncol. 2023;18(6):769-779. doi: 10.1016/j.jtho.2023.01.083.

3. Nadal E, Rodríguez-Abreu D, Simó M, et al., Phase II trial of atezolizumab combined with carboplatin and pemetrexed for patients with advanced nonsquamous non-small-cell lung cancer with untreated brain metastases (Atezo-Brain, GECP17/05). J Clin Oncol. 2023;41(28):JCO.22.02561. doi: 10.1200/JCO.22.02561.

389 | Multidisciplinary approach to atypical parathyroid tumours and severe hypercalcemia

Sahil Goel¹, Nicholas Giannopoulos ¹, Anthony Colella¹, Suren Krishnan¹

¹Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia

Background: Atypical parathyroid tumours (APT) comprise a set of lesions causing primary hyperparathyroidism (PHPT) with almost identical clinical manifestations to parathyroid carcinomas. Given uncertainty surrounding their malignancy potential, these lesions warrant prompt diagnosis and multidisciplinary management. We present an additional case of APT with resultant primary hyperparathyroidism and severe hypercalcemia.

Results: A 66-year-old Caucasian male was hospitalised with an infective exacerbation of his chronic obstructive pulmonary disease and was incidentally found to have severe hypercalcemia and concurrent hyperparathyroidism. Further workup revealed a sestamibi-avid mass in the inferior pole of the right thyroid lobe which was abutting the thoracic inlet and displacing the oesophagus to the left. The patient was managed in a multidisciplinary setting with endocrine involved in stabilisation of the cardiac membrane with the use of zoledronic acid and calcitonin. The patient was prepared for urgent surgical removal of the tumour prior to the suspected rebound tachyphylaxis with prolonged calcitonin use. The patient was discharged on day 14 with an elevated parathyroid hormone (PTH) concentrations of 34.2 pmol/L at time of discharge.

Discussion: Our case highlighted extremely high PTH levels (181.9 pmol/L) in APT at time of admission. Literature suggests APT PTH levels are higher than parathyroid carcinomas, however this different is statistically non-significant with a lack of case reports published. Despite surgical resection, the PTH remained elevated at 34.2 pmol/L at time of discharge and is likely multifactorial secondary to high bone turnover markers and hungry bone syndrome.

Conclusion: APT and parathyroid carcinomas are both rare yet serious neoplasms that demonstrate similar clinical presentations. Larger trials and further case reports need to be published to assess whether preoperative PTH is a suitable marker to distinguish between these two entities. These tumours need to be managed in a tertiary centre in a multidisciplinary format.

390 | Patterns of care, clinical outcomes and patient reported measures for people diagnosed with mesothelioma in Victoria

Susan Harden¹, Sanuki Tissera¹, Mike Lloyd¹, Rob Stirling¹

¹PHPM, Monash University, Melbourne, VIC, Australia

Background: Mesothelioma is a rare asbestos-related cancer with a high disease burden, often with poor outcome. The Victorian Mesothelioma Outcomes Registry was established in 2022, as a sub-study of the VLCR, to collect clinical information, report on standards of care and advocate for equity of access to life-extending treatments. Key quality indicators were identified through a modified Delphi process and a co-designed survey collecting patient reported outcomes and experiences was developed and introduced.

Methods: People diagnosed with mesothelioma during 2022–2023 were identified through HHIS coding extracts (ICD C45) received by the registry. People were invited to participate via opt-out consent and, from 2023, to then complete a bespoke survey. Clinical data was collected at the participating hospitals and entered into a secure database. Patient surveys were either returned electronically or by mail and entered into the same database.

Results: 182 participants from 19 health services were registered during 2022–2023. 77% were men, median age was 74 with 91% pleural mesothelioma. 65% were presented at MDM, 71% had histologic subtyping, 62% had prior asbestos exposure documented in the medical record and 30% had access to a specialist cancer nurse. Systemic anti-cancer therapy (SACT) with chemotherapy and/or immunotherapy was received by 56%. One year overall survival was 53% for the whole cohort and significantly higher (0.74 [0.62–0.83], p < 0.001) for those receiving SACT compared to those who did not (0.21 [0.11–0.33]). To date, the response rate to our patient reported outcome and experience survey is 39%.

Conclusions: This real-world data supports trials showing improved survival for people with mesothelioma who receive SACT and is an opportunity to understand why 44% did not. Access to cancer nurse specialists remains low for this high burden cancer and we hope to learn from people's survey responses how best to increase support for them and their carers.

391 | Coordination of care in the context of primary brain tumours: Healthcare professionals’ exploration of the unspoken impact and clinical implications

Megan S. Jeon¹, Joanne Shaw¹, Hannah Banks¹, Dianne M. Legge^2,3, Sharon He¹, Thomas Carlick¹, Eng-Siew Koh^4,5, Georgia Halkett³, Brian Kelly⁶, Mark B. Pinkham^7,8, Tamara Ownsworth⁹, Raymond J. Chan¹⁰, Haryana Dhillon¹

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

²Oliva Newton-John Cancer and Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia

³Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia

⁴Liverpool Cancer Centre, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia

⁵South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia

⁶School of Medicine and Public Health, University of Newcastle (UON), Callaghan, NSW, Australia

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

⁸University of Queensland, St Lucia, QLD, Australia

⁹The Hopkins Centre, School of Applied Psychology, Griffith University, QLD, Australia

¹⁰Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford, SA, Australia

Aim: People with primary brain tumours (PwBT) and their families experience high distress and face challenges navigating their disease and treatment, the healthcare system, and/or survivorship. Quality care coordination enables continuous, timely care according to the individual care needs of PwBT. We aimed to explore healthcare professionals’ (HCPs) practices and perceptions about neuro-oncology care coordination (NOCC).

Methods: We conducted a qualitative study using semi-structured interviews via videoconferencing. Participants were HCPs providing neuro-oncology care. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using interpretive description, following the Consolidated Criteria for Reporting Qualitative Research.

Results: We interviewed 12 HCPs from Australia and New Zealand between June and November 2023. The median interview duration was 58 min. Participants had a median of 13 years of experience in neuro-oncology across medical, nursing, and allied health disciplines. NOCC models were not standardised. We identified five themes related to NOCC: (1) Vulnerable and complex PwBT and families: PBT is a unique cancer generating pervasive, multifaceted disabilities; (2) Tailored coordination: Shaping and tailoring NOCC is in the best interests of PwBT and families; (3) Going the extra mile: Care needs warrant proactive support, which is often unfunded to mitigate crisis; (4) Emotionally demanding: HCPs manage emotional weight with limited support; and (5) Barriers to effective care: Limited resources impact HCPs’ capacity to deliver the optimal standard of care.

Conclusion: PwBT experience a unique and complex set of care needs requiring specialist skills and knowledge beyond general oncology care coordination. NOCC encompasses continuous coordination of multidisciplinary care to optimise functional living for PwBT. Given the complexity of the NOCC role, better support infrastructure with training and resources for HCPs is needed to retain HCPs and prevent burnout. These findings will inform further research to identify support, training and resource needs for HCPs and implement appropriate interventions.

392 | Glioma carers – Assessment of individual needs and support (The GAINS study): A single arm pilot study of nurse-led support for carers of people with high-grade glioma (HGG) [HREC: 89349]

Diana Jones^1,2, Raymond J. Chan^1,2,3, Mark B. Pinkham^2,3, Carla Thamm^1,2, Vanessa Beesley^3,4, Matthew P. Wallen^1,5

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

²Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia

³Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia

⁴Supportive Care in Cancer Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

⁵School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia

Introduction: A diagnosis of high-grade glioma (HGG) can have devastating impacts for patients and their carers, with carers reporting diverse unmet needs and significant distress. Our recent systematic review identified no supportive care interventions addressing the unmet needs of carers during the radiation phase of treatment. A nurse-led supportive intervention delivered during radiation is an opportunity to address carers’ unmet needs early in the illness trajectory.

Aims: To examine the feasibility, acceptability, and preliminary effects of a nurse-led intervention to identify and address the unmet needs of carers for people with HGG.

Methods: This is a single group, pre-post study design. Twenty (n = 20) carers of people with newly diagnosed HGG, planned for a minimum of 15 fractions of radiation, will be recruited from radiation oncology clinics at the Princess Alexandra Hospital in Brisbane, Australia. Carers will complete a neuro-oncology needs screen identifying priority areas for support. The cancer nurse researcher/PhD candidate will meet with the carer (face-to face or by phone) during the patient's radiation treatment to offer support to manage the identified caregiving issues, with an optional needs screening approximately four weeks after the completion of radiation.

Results: Data pertaining to carer preparedness, competence/confidence, strain, positive appraisal of caregiving, family well-being, and distress will be collected at three time points: baseline, end of radiation treatment and 6 weeks post radiation. Semi-structured interviews and surveys will explore the GAINS intervention from the perspective of the participating carers, their patients, and health professionals caring of the patient-carer dyad.

Conclusions: The GAINS study commenced recruiting at Princess Alexandra Hospital in 2023, with 15 (n = 15) carers currently enrolled or having completed all study components. Preliminary findings indicate most carers prefer face-to-face sessions to explore diverse needs, with duration of sessions ranging 15–65 min.

393 | Accommodating the diagnosis of low-grade glioma: An interpretive interview study

Dianne M. Legge^1,2, Danette H. Langbecker^2,3, Patsy Yates⁴

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

²Institute for Biomedical Health Innovation, Queensland University of Technology, Brisbane, QLD, Australia

³Centre for Online Health, University of Queensland, Brisbane, QLD, Australia

⁴Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia

Background: Significant treatment and resource allocation are directed towards improving the support and services for people with high-grade glioma, given significant care burden and high supportive care needs. People diagnosed with the rarer low-grade glioma (LGG) often live for an extended period following diagnosis, finding ways to manage family, work, health, and relationships. This study explored the supporting social processes undertaken to accommodate a LGG diagnosis.

Material and Methods: Symbolic interactionism was the lens for this work, incorporating Charmaz's grounded theory methods to identify the social processes undertaken in accommodating LGG. Semi-structured interviews were conducted with people diagnosed with LGG. Purposively selecting participants for their rich contribution to the data. All interviews were audio-recorded and transcribed verbatim. Data analysis occurred concurrently with interviews to co-construct social processes, ensuring emerging concepts remained grounded in the data. Concepts were confirmed through coding and constant comparison. Data analysis was managed through NVivo(v11.4).

Results: Interviews were conducted with 13 people with grade 2/3 gliomas in late 2016, median of 67 min. Participants were from Australia, (both rural and urban) and median of 4.5 years since diagnosis. ‘Accommodating Life Disruption’ emerged with three supporting social processes describing how people dealt with a diagnosis of LGG: (1) Dealing with contradictions; identifying ambiguous clinical context and language and narrative used in LGG; (2) Defining time; marking a point in time for taking stock of resources; (3) re-negotiating identity; how people with LGG take control, make connections and create a good life.

Conclusion: This study highlights the unique social processes undertaken to accommodate the diagnosis of LGG and identifies clear targets for improving supportive care resources and survivorship practices for people with LGG. The findings also offer opportunities to consider and improve how health professionals interact and communicate the diagnosis for people with LGG and their families.

394 | Identifying psychological well-being needs in people diagnosed with sarcoma, their carers, and health professionals: A qualitative study

William Lorimer¹, Moira O'Connor², Mandy Basson³, Erinna Ford⁴, Georgia Halkett⁵

¹School of Nursing, Curtin University, Perth, Western Australia, Australia

²School of Population Health, Curtin University, Perth, Western Australia, Australia

³Sock it to Sarcoma!, Perth, Western Australia, Australia

⁴Ninox Cancer Support Crew, Perth, Western Australia, Australia

⁵School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, Western Australia, Australia

Background: Addressing the psychological well-being of people diagnosed with sarcoma, their carers, and health professionals is crucial for comprehensive care.¹ This study aims to identify the needs of those within these groups to inform the development and design of a guide to assist with managing and improving psychological well-being.

Methods: A qualitative exploratory descriptive approach was used to gather rich data through semi-structured interviews. Participants included people diagnosed with sarcoma (aged 16–80 years and post-active treatment up to 10 years), their informal carers (aged 18–80 years, bereaved or non-bereaved), and health professionals who work with people diagnosed with sarcoma and their carers across a range of disciplines.

Data Collection and Analysis: Interviews, in-person and online, were recorded and transcribed. A directed content analysis, guided by the PERMA model² and Ryff's theory of psychological well-being,³ is being used to identify key themes and concepts. The analysis will follow Bengtsson's⁴ four-stage process: de-contextualisation, re-contextualisation, categorisation, and compilation. This method ensures a thorough analysis of the data, capturing the diverse experiences and needs of participants.

Preliminary Results: To date, ten interviews have been conducted with people diagnosed with sarcoma (N = 6), informal carers (N = 3), and health professionals (N = 1). Preliminary themes and concepts include ‘Emotions and Regulation’, ‘Controlling what I can’, ‘Life-altering acceptance’, and ‘Comprehensive care’.

Expected Outcomes: The study will uncover insights into the psychological well-being needs of people diagnosed with sarcoma, carers, and health professionals. These insights will inform the content of the well-being guide, providing targeted support and resources for people diagnosed with sarcoma and their carers.

Conclusion: This research will contribute to the development of an effective, user-informed guide. This guide will enhance the psychological support available to people diagnosed with sarcoma and their carers, improving overall well-being and quality of life.

References:

1. Zimmermann FF, Burrell B, Jordan J. The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: a systematic review. Compl Ther Clin Pract. 2018;30:68-78.

2. Seligman MEP. Flourish: A Visionary New Understanding of Happiness and Well-being. Free Press.

3. Ryff CD, Keyes CLM. The structure of psychological well-being revisited. J Person Soc Psychol. 1995;69(4):719-727.

4. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nurs Plus Open. 2016;2:8-14.

395 | Case report: Hereditary leiomyomatosis and renal cell cancer treated with bevacizumab and erlotinib

Sarah Lumchee¹, Aaron Hansen²

¹Pharmacy Department, Ramsay Pharmacy, Greenslopes Private Hospital, Brisbane, Queensland, Australia

²Cancer Services, Princess Alexandra Hospital, Queensland Health, Brisbane, Queensland, Australia

Background: Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare and underreported hereditary syndrome resulting from a fumarate hydratase (FH) pathogenic variant. It is characterized by cutaneous leiomyomata, uterine fibroids and/or renal cell carcinoma. Management of HLRCC lacks robust evidence, although promising results in case series have been reported with the use of bevacizumab and erlotinib for advanced disease.

Case Presentation: A 35-year-old male presented to his general practitioner with back pain. His background included childhood asthma and prior appendectomy. He was married with two daughters. His family history was significant for kidney cancer in his father.

Investigations: Ultrasound and computed tomography revealed a large left renal mass and lesions in the left 7th and right 11th ribs. Biopsy demonstrated metastatic renal carcinoma with histopathology composed of oncocytic cells arranged in a tubulocystic pattern with heterogeneous FH staining and positive IHC making this highly suspicious for HLRCC. Germline testing demonstrated heterozygous variant of uncertain significance (VUS) in FH gene (c.1016C > A in exon 7).

Treatment: Radiotherapy to the left 7th rib, scapula and right 10th rib was performed followed by systemic therapy with intravenous bevacizumab 10 mg/kg two-weekly and oral erlotinib 150 mg daily. Despite four cycles of therapy, restaging demonstrated rapid widespread progression of bony disease. The patient proceeded to further radiation therapy and second line treatment with cabozantinib.

Discussion: As is typical for HLRCC, this patient presented with advanced disease which rapidly progressed and was refractory to anti-tumour effects of bevacizumab and erlotinib. Additionally, the patient yielded a FH variant which has been associated with HLRCC but for which there is insufficient evidence to determine its impact on management. With increasing use of genetic testing, there has been rapid expansion of VUS identification. Further research to understand the pathogenicity of variants would enhance clinical decision-making for management and surveillance.

396 | Population based analysis of carcinoma of unknown primary – Patterns of care and outcomes in regional victoria

Graham Pitson¹, Melinda Mitchell¹, Leigh Matheson¹

¹Barwon South Western Regional Integrated Cancer Service (BSWRICS), Geelong, VIC, Australia

Aims: Carcinoma of unknown primary (CUP) is a carcinoma diagnosed at a metastatic site where, after appropriate investigation, the primary site cannot be found. It is a disease with a poor prognosis where historically treatment options are limited and palliative. There is little recent published data on how patients are treated in routine practice in Victoria, Australia. The aim of this study was to perform a review of patterns of care for CUP in regional Victoria.

Methods: The Evaluation of Cancer Outcomes (ECO) Registry records clinical and treatment information on all newly diagnosed cancer patients in the Barwon South West Region (BSWR) of Victoria encompassing approximately 380,000 people. This study analysed patterns of care and outcomes for all CUP patients (as defined by the treating clinician) diagnosed in the BSWR from 2009 to 2017.

Results: There were 442 patients diagnosed with CUP during the 9 year period, with a median age of 77 (range 16–98). The most common histological diagnosis was an untyped neoplasm (146), adenocarcinoma (131) or squamous cell carcinoma (37). The majority of patients (291, 66%) were recorded as not having received any disease modifying therapy with a minority of patients (82, 18%) receiving intravenous systemic therapy (usually carboplatin or cisplatin with smaller numbers receiving etoposide, paclitaxel or gemcitabine). One hundred and eight patients (24%) received palliative radiotherapy. Only 5% of patients were recorded as having any treatment outside the region. The median survival for all patients was 2.23 months, with a slight improvement in the period 2014–2017 compared to 2009–2013 (3.0 vs. 2.1 months). Patients deemed fit enough to receive systemic therapy had a median survival of 9.8 months.

Conclusion: This population-based analysis has confirmed the continuing poor outlook of this patient group with a median of less than 3 months. CUP remains an area of unmet clinical need.

398 | Bridging gaps in TNBC: Comparative analysis of patient demographics and treatment patterns between Australia and EU4+UK countries

Imogen Smith¹, Clara Brown¹, James Etwell¹, Lawrence Farrell¹, Emma Peffer¹, Euan Wilson¹, Aneta Suder²

¹IQVIA, NSW, Australia

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

Aim: Triple-negative breast cancer (TNBC) constitutes 10%–15% of global breast cancer cases, with patients typically experiencing a poor prognosis. However, there is a lack of global comparative studies on TNBC patients in real-world settings. This study aims to bridge this gap by comparing patient demographics and treatment between Australian and EU4+UK patients.

Methods: We analysed anonymised patient-level data from the cross-sectional online survey conducted by the IQVIA Oncology Dynamics real-world data database. Australian cohort (n = 71) covered 2022–2024, while EU4+UK cohort (n = 1800) covered the most recent moving- annual-total (MAT) to March 2024. We focused on patient demographics and treatment patterns across first (1L) second (2L) and third+ (3L+) lines.

Results: TNBC prevalence: 9% (Australia) versus 12% (EU4+UK). Majority aged 51–70, with 59% post-menopausal (Australia) and 62% (EU4+UK). 89% of Australian patients had an ECOG of 0 or 1, compared to 93% in the EU4+UK cohort. Private funding was used by 13% of Australian patients and 4% in EU4+UK patients. In the UK, 32% received funding through the ‘Cancer Drug Fund’, with public funding at 65%.

A higher proportion of EU4+UK patients had advanced/metastatic disease compared to Australian patients (54% vs. 44%). In 1L treatment, taxane-monotherapy was most common in Australia (50%), whereas PD-1/PD-L1 inhibitors were predominant in EU4+UK (39%). In 2L treatment, PARP inhibitor/chemotherapy regimens were most frequently administrated in Australia (63%), compared to sacituzumab govitecan (SACGO) in the EU4+UK (34%). In 3L+, SACGO was the most utilised treatment in both groups (Australia: 50% vs. EU4+UK: 53%).

Conclusion: This study highlights disparities in treatment funding, particularly in the UK and therapy utilisation between Australia and EU4+UK countries, underscoring the need for aligned treatment protocols and equitable access to care. Bridging these gaps will facilitate progress in global cancer care, breaking down disparities and potentially improving outcomes for TNBC patients worldwide.

399 | Real world experience with gemcitabine, cisplatin and durvalumab for first line treatment of advanced biliary tract cancers in Australia – Preliminary results

Rebecca Symons^1,2, David Lau^3,4, Julia Freckelton⁴, Niall Tebbutt⁵, Georgios Iatropoulos⁴, Andrew Dean⁶, Maclain Robinson⁶, Nimit Singhal⁷, David Goldstein¹

¹Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia

²Department of Medical Oncology, St George Hospital, Kogarah, NSW, Australia

³Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

⁴Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia

⁵Department of Medical Oncology, Olivia Newton John Cancer Wellness and Research Centre, Melbourne, VIC, Australia

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

⁷Department of Medical Oncoloy, Royal Adelaide Hospital, Adelaide, SA, Australia

Introduction: Randomized controlled trials are the gold standard for efficacy and safety evidence in oncology. However, with restricted eligibility and often limited population diversity, they can lack generalisability, particularly in rare cancers. The TOPAZ-1 randomised trial demonstrated improved survival with first line gemcitabine, cisplatin and durvalumab compared to chemotherapy alone in advanced biliary tract cancer.¹ The aim of this study is to evaluate the efficacy and safety of this regimen in a real-world Australian cohort.

Methods: This is a retrospective study of first line gemcitabine, cisplatin and durvalumab at multiple Australian sites. Data on demographics, treatment, toxicities and survival were collected.

Results: From February 2022 to January 2024, 17 patients commenced treatment at Prince of Wales and St. George Hospitals, Sydney. Median age was 60-years (range 41–77 years). 71% had intrahepatic cholangiocarcinoma. Fifteen (88%) had metastatic disease at baseline. Four patients had prior resection and three had received prior adjuvant chemotherapy. At data cut off on 31 January 2024, median follow up was 9.3 months (range 3.3–23.3), two patients continue on treatment and six patients had died. There were four partial and one complete response [ORR 29%]. Median DOR was 5.5 months. The median PFS was 4.1 months (95% CI 3.0–6.2). Median OS has not been reached. Nine (53%) patients had at least one toxicity, mostly grades 1–2, two grade 3 anaemia and one grade 3 neutropaenia. There were no high-grade immune related toxicities. Data from additional sites in Victoria and Western Australia will be presented at COSA ASM.

Conclusions: Real-world evidence is an important adjunct to the evidence from randomised controlled trials. The preliminary results from this study have demonstrated similar ORR and DOR but lower median PFS of 4.1 months, compared to TOPAZ-1 (median PFS 7.2 months (95% CI 6.7–7.4)), with manageable toxicity. Longer follow up is required.

400 | Mesothelioma incidence rates in Australia since 1982: Exploring age, period and cohort effects and future projections

Karen Walker-Bone¹, Ewan MacFarlane¹, Geza Benke¹, Sonja Klebe², Fraser Brims³, Tim Driscoll⁴, Elizabeth Chalker⁵

¹Monash Centre of Occupational and Environmental Health, Monash University, Melbourne, Victoria, Australia

²Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia

³Curtin Medical School, Curtin University, Perth, Western Australia, Australia

⁴School of Public Health, University of Sydney, Sydney, NSW, Australia

⁵ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia

Background: Use of asbestos-containing products was banned in Australia in 2003. However, rates of new cases of mesothelioma have continued to increase. The aim of this study was to investigate mesothelioma incidence in Australia by year of birth and age-period-cohort analysis and to develop projections of expected mesothelioma cases to 2033.

Methods: Data came from the Australian Cancer Database which provides complete national records of mesothelioma cases notified 1982–2019. Incidence rates were age-standardised to the 2001 Australian Standard Population to enable comparisons of the population across time. Age-period-cohort models were used to examine the temporal trends of incidence rates by age, calendar year and birth cohort. Projections for incidence rates of mesothelioma 2020–2033 were estimated using Nordpred models.

Results: Amongst older people (55 years+), age-standardised mesothelioma incidence rates increased as the median year of birth approximated 1930. There was a strong birth cohort effect with highest rates amongst those born before 1949. Projection modelling to 2033 suggested that the age-standardised and crude incidence rates of mesothelioma will continue to decline. Most of this decline will be amongst people aged 60–84 years.

Discussion: The findings are consistent with the greatest risk of mesothelioma in Australia occurring with the highest levels of cumulative occupational exposure that occurred historically. Unfortunately, the numbers of new cases are not expected to decline until after 2030.

401 | Educational needs of patients with a pre-disposition to vulval cancer: An audit and cross-sectional survey

Natalie Williams^1,2, Natarsha Wilson³, Hayley Fleay³, Bernie McElhinney³

¹Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, WA, Australia

²Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

³King Edward Memorial Hospital, Subiaco, WA, Australia

Aims: A systematic approach to surveillance of pre-cancerous vulval conditions such as vulval intraepithelial neoplasia (VIN), and vaginal intraepithelial neoplasia (VAIN) and vulval dermatoses such as lichen sclerosis (LS) is recommended best practice care in the early detection of vulval cancer. Patients with gynaecological cancers have significant unmet information needs, however the extent of the problem in this population is unknown. This project aimed to audit the patient population attending a vulvoscopy clinic at a Western Australian tertiary centre and assess knowledge and information needs.

Methods: A retrospective audit examined demographic data of 307 patients attending the vulval clinic for surveillance. A cross-sectional survey collected quantitative and qualitative data from 61 clinic attendees between January and March 2024. Participation exceeded the expected number of 50. Data underwent descriptive statistical and content analysis.

Results: Most audited patients attended with VIN, VAIN or LS conditions (n = 212; 69%). Patients age ranged from 17 to 101 years. Most (62%; n = 189) were born in Oceania and four (1%) were Aboriginal or Torres Strait Islander.

In self-assessing understanding of their condition, most respondents (n = 23; 48%) provided a description of symptoms. Most (n = 49; 84%) were confident in vulva care, however, almost half (n = 27, 46%) self-reported low knowledge.

Most respondents (n = 51; 85%) were unaware of the available consumer resource centre. Face-to-face appointments with a health professional was the preferred way to receive education (n = 48; 79%). There was interest in patients attending support group or education sessions. Most (n = 50; 85%) indicated they would use an information pack including a variety of resource formats.

Conclusions: Knowledge and confidence results suggest patients know how to effect vulva care; however, they may not understand why. The investigation benchmarked information needs for this population and results will assist in developing strategies to provide support and education on the prevention of progression to cancer.

402 | Building evidence for vulvar cancer wound care: Benchmarking practice in Australia and New Zealand

Natalie Williams^1,2, Megan Wall², Sharon Maclean¹, Emma Allanson³

¹Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

²Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, WA, Australia

³King Edward Memorial Hospital, Subiaco, WA, Australia

Publish consent withheld.

403 | What affects a carer's decision to seek support for themselves? A systematic review to understand psychological support-seeking among carers

Hannah Banks¹, Rebekah Laidsaar-Powell¹, Haryana Dhillon¹, Helen M. Haydon^2,3, Sarah Giunta¹, Kyra Webb¹, Joanne Shaw¹

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

²The Centre for Online, The University of Queensland, Brisbane, QLD, Australia

³The Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia

Background: Carers are the ‘invisible backbone‘ of our healthcare systems, providing essential support to people with chronic physical health conditions. Yet many face significant unmet needs, burdens and psychosocial concerns. Psychological interventions can help carers to manage these impacts, however, carers often demonstrate low engagement with mental health services. In addition to practical and system-level barriers, carers’ role perceptions and attitudes to mental health services may deter them from accessing crucial support for themselves.

Aims: This systematic review aimed to (a) assess the prevalence of psychological support-seeking and mental health service use among carers of people with a chronic physical health condition; (b) identify attitudinal barriers and facilitators; and (c) identify and describe interventions designed to increase engagement with psychological services among carers.

Methods: Following PRISMA guidelines, we systematically searched PsycINFO, MEDLINE, CINAHL and EMBASE for peer-reviewed articles published in English from 2005-2024 reporting on adult carers of people with a chronic physical health condition seeking psychological support for themselves. Study quality was assessed using the CASP Qualitative Checklist and NIH Study Quality Assessment Tool.

Preliminary Results: We identified 8844 studies, with 166 eligible for full-text review. Fifty-one studies were included for analysis: 24 qualitative, 23 quantitative and 4 mixed methods. Thirty-one studies (61%) were cancer-specific. Overall, quantitative studies reported low rates of carers seeking and accessing psychological services for themselves. Common barriers identified in qualitative studies included prioritising the patient's needs, low levels of perceived need, mental health stigma, and poor knowledge of available support. No interventions were specifically designed to increase uptake of mental health services among carers.

Conclusion: Our results demonstrate a gap in interventions, tools, and strategies to increase support-seeking among carers experiencing psychological distress. These results will inform the development of a novel, cancer-specific intervention to increase uptake of psychological health services among carers.

404 | Do neuro-oncology care coordinator position descriptions match the care roles staff report?

Hannah Banks¹, Megan Jeon¹, Sharon He¹, Brian Kelly², Haryana Dhillon¹

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

²School of Medicine and Public Health, University of Newcastle (UON), Callaghan, NSW, Australia

Background: Navigating a primary brain tumour (PBT) diagnosis often requires specialist support and care due to the unique, multifaceted and devastating impacts of the disease and its treatment. Neuro-oncology care coordination (NOCC) can mitigate these challenges by providing continuous and timely care tailored to individual needs. While NOCC is commonly based on nurse-led models of care, a lack of standardisation has created ambiguity in the roles and responsibilities of healthcare professionals (HCPs) involved in NOCC.

Aim: We aimed to compare formal position descriptions with the experiences and perceptions of HCPs involved in NOCC.

Methods: Semi-structured interviews were conducted with HCPs involved in clinical neuro-oncology care. Participants were asked about their perceptions of NOCC and asked, where possible, to provide a copy of their official position description. Interviews were transcribed verbatim and position descriptions converted to a standardised template, before undergoing qualitative thematic analysis. Necessary qualifications, key capabilities, roles and responsibilities were extracted and compared across the two datasets.

Results: We interviewed 12 HCPs from Australia and New Zealand and were provided with six position descriptions. The median interview length was 58 min and position descriptions varied in detail provided. Role and responsibilities were categorised into coordination, institutional, and resource-related duties. Coordination-related duties, multidisciplinary collaboration, referrals and clinical consultancy were commonly reported in interviews and position descriptions. In the interviews, almost all participants commented on their role as a key, trustworthy point of contact who provides emotional support and psychological first aid to patients and carers. However, only two position descriptions included providing psychological support as a key duty.

Conclusion: NOCC position descriptions are inconsistent across practice settings and fail to recognise the relational and emotional labour required as part of NOCC. Core duties of NOCC staff need review to ensure they reflect the components of care provided.

405 | Utilisation of endocrine therapy for cancer in Indigenous peoples worldwide: A systematic review and meta-analysis

Sewunet Admasu Belachew¹, Habtamu Mellie Bizuayehu¹, Shafkat Jahan¹, Abbey Diaz¹, Siddhartha Baxi², Kalinda Griffiths^3,4,5, Gail Garvey¹

¹First Nations Cancer and Wellbeing (FNCW) Research Program, School of Public Health, The University Of Queensland, WINDSOR, QLD, Australia

²GenesisCare Australia, Griffith University, Gold Coast, QLD, Australia

³Poche SA+NT, Flinders University, Darwin, Northern Territory, Australia

⁴Menzies School of Health Research, Darwin, Northern Territory, Australia

⁵Centre for Big Data Research in Health, UNSW, Sydney, New South Wales, Australia

Aims: Indigenous peoples worldwide experience inequitable cancer outcomes, and it is unclear if this is underpinned by differences in or inadequate use of endocrine treatment (ET), often used in conjunction with other cancer treatments. Previous studies examining ET use in Indigenous peoples have predominately focused on the sub-national level, often resulting in small sample sizes. This systematic review aimed to collate the findings of articles on ET utilisation for Indigenous cancer patients and describe relevant factors that may influence ET use.

Methods: We conducted a systematic review and meta-analysis of studies reporting ET use for cancer among Indigenous populations worldwide. PubMed, Scopus, CINAHL, Web of Science, and Embase were searched. A random-effect meta-analysis was used to pool proportions of ET use.

Results: Thirteen articles reported ET utilisation among Indigenous populations, yielding a pooled estimate of 67% (95% CI: 54−80), which is comparable to that of Indigenous populations 67% (95% CI: 53−81). However, among studies with sample/cohorts (≥500), Indigenous populations had a 14% (62%; 95% CI: 43−82) lower ET utilisation than non-Indigenous populations (76%; 95% CI: 60−92). The ET rate in Indigenous peoples of the USA (e.g., American Indian) and New Zealand (e.g., Māori) was 72% (95% CI: 56–88) and 60% (95% CI: 49–71), respectively. Compared to non-Indigenous populations, a higher proportion of Indigenous populations were diagnosed with advanced cancer, at younger age, had limited access to health services, and lower socio-economic status

Conclusions: Indigenous cancer patients have lower ET utilisation than non-Indigenous cancer patients, despite the higher rate of advanced cancer at diagnosis. While reasons for these disparities are unclear, they are likely reflecting, at least to some degree, inequitable access to cancer treatment services. Strengthening the provision of and access to culturally appropriate cancer care and treatment services may enhance ET utilisation.

406 | Healthcare professional views on malnutrition and muscle loss in patients with ovarian cancer

Sarah Benna-Doyle^1,2, Nicole Kiss^1,2,3, Erin Laing^2,3,4, Jenelle Loeliger^1,2,3,4, Brenton Baguley^1,2,3

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

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

³Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

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

Background and Aims: Ovarian cancer is a relatively rare and fatal cancer (49% 5-year survival rate). Patients are at high risk of malnutrition and muscle loss due to advanced-stage diagnosis and increased treatment severity. Evidence-based guidelines recommend all patients with cancer are screened for malnutrition and sarcopenia to reduce associated adverse consequences including reduced treatment tolerance and survival. This study aimed to describe the awareness and perceptions of nutrition issues and current nutrition-related practices among healthcare professionals (HCP) treating patients with ovarian cancer in Australia.

Methods: A national cross-sectional survey was completed between November 2023 and March 2024. The 24-item purpose-designed survey evaluated awareness and perceptions of nutrition-related issues, screening and referral practices, and barriers to providing nutrition services in ovarian cancer.

Results: HCPs (n = 57) were predominantly nurses (38.6%), dietitians (22.8%) or surgeons (19.3%). Overall, weight loss (67%), overweight and obesity (54.4%) and muscle loss (44%) at diagnosis and weight loss (67%) and muscle loss (63.2%) during treatment were the most observed issues. Perceptions of the importance of malnutrition and sarcopenia varied; however, medical professionals were less likely to consider them important. Chemotherapy was identified as the treatment with greatest malnutrition risk (96.5%), yet 21% of health services did not screen for malnutrition, 57.9% did not screen for sarcopenia and 75.4% of participants reported patients made self-directed dietary changes during treatment. Key barriers to providing nutrition care were a lack of established processes for sarcopenia screening (75%), limited dietetic services (60%), and lack of referral pathways specific to patients with ovarian cancer (58%).

Conclusion Perceptions of the importance of malnutrition and sarcopenia in ovarian cancer vary according to professional discipline despite robust evidence on their importance to clinical outcomes. The results identify inconsistencies in screening practices and highlight the need for ovarian cancer-specific referral pathways to guide appropriate nutrition care.

407 | Concordance of colorectal cancer care with optimal care pathway recommendations: A pre-post study

Rebecca J. Bergin^1,2,3, Dallas English^2,4, Sabrina Wang^2,4, Jon D. Emery¹, David Hill^5,6,7, Kathryn Whitfield⁸, Robert J. Thomas^2,9, Anna Boltong^10,11, Paul Mitchell¹², David Roder¹³, Euan Walpole^14,15, Roger L. Milne^2,4,16, Victoria White^6,17

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

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

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

⁶Behavioural Science Division, Cancer Council Victoria, Melbourne, VIC, Australia

⁷Health Behaviour Research Collaborative, University of Newcastle, Callaghan, NSW, 2308

⁸Victorian Government, Melbourne, VIC, Australia

⁹Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia

¹⁰Department of Nutrition, Dietetics and Food, Monash University, Clayton, VIC, Australia

¹¹Kirby Institute, University of New South Wales, Sydney, NSW, Australia

¹²Austin Health, Melbourne, VIC, Australia

¹³Cancer Institute NSW, Sydney, NSW, Australia

¹⁴Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

¹⁵Department of Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia

¹⁶Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia

¹⁷School of Psychology, Deakin University, Melbourne, VIC, Australia

Aims: Optimal care pathways (OCPs) are standards for cancer care that aim to reduce unwarranted variation and improve patient outcomes. This study compared concordance with colorectal cancer OCP recommendations before and after the introduction of OCPs in Victoria, Australia.

Methods: Cross-sectional surveys were conducted of two groups of patients identified by the Victorian Cancer Registry with a primary colorectal cancer, and their general practitioners (GPs): the first in 2012–2014 (pre-OCP), the second in 2018–2019 (post-OCP). Poisson regression examined the relative difference in the proportion of patients receiving care concordant with OCP recommendations for timeliness of care, diagnostic investigations and treatment, before and after implementation. Exploratory analyses examined disparities in timeliness of care by socio-economic position or remoteness of residence.

Results: The pre-OCP group included 413 patients (43% response) and 275 GPs; the post-OCP group 320 patients (34% response) and 201 GPs. Surveys were completed a median 6-months (pre-OCP) and 7-months (post-OCP) post-diagnosis.

Both groups had similar concordance with recommended timeframes to receive a colonoscopy or surgeon appointment, and to start neoadjuvant treatment or adjuvant chemotherapy. Concordance with recommendations for investigating symptoms was lower in the post-OCP group, especially for physical examination (relative risk [RR] = 0.71; 95% confidence interval [CI] 0.57–0.89, p = 0.003). Rectal cancer patients were more likely to have an MRI post-OCP (RR = 1.31; 95%CI 1.03–1.66, p = 0.027).

Estimates consistently indicated that patients residing in rural or low socio-economic areas were less likely to receive care in accordance with OCP recommended timeframes than their urban, high socio-economic counterparts. Disparities by socio-economic status were consistent pre- and post-OCP, but disparities by remoteness increased.

Conclusions: There were limited changes in delivery of OCP recommended care early after policy introduction. A comprehensive implementation strategy is needed to embed OCPs in practice, with a sustained focus on disparities, given existing and growing inequities for some populations.

408 | How should we design study invitation materials for cancer survivorship research? Findings from a consumer consultation study

Xanthia E. Bourdaniotis¹, Susannah K. Ayre^1,2, Elizabeth (Lizzy) A. Johnston^1,2,3, Leah Zajdlewicz¹, Vanessa L. Beesley^4,5,6, Jason D. Pole^7,8, Aaron Hansen^9,10, Harry Gasper^10,11,12, Danica Cossio¹³, Gemma Lock¹⁴, Belinda C. Goodwin^1,15,16

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

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

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

⁴School of Psychology, The University of Queensland, Brisbane, QLD, Australia

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

⁶Psychedelic Medicine and Supportive Care Lab, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

⁷Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia

⁸Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada

⁹Princess Alexandra Hospital, Brisbane, QLD, Australia

¹⁰School of Medicine, The University of Queensland, Brisbane, QLD, Australia

¹¹Centre of Health, University of Southern Queensland, Springfield, QLD, Australia

¹²Coastal Cancer Care, Birtinya, QLD, Australia

¹³Cancer Alliance Queensland, Brisbane, QLD, Australia

¹⁴Cancer Council Queensland, Brisbane, QLD, Australia

¹⁵Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia

¹⁶School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia

Aims: Consumer involvement in the design of study materials can ensure their relevance and sensitivity to the target population, leading to higher enrolment rates. This study aimed to co-design and test study invitation materials that are relevant and acceptable to cancer survivors and their caregivers for a population-based survey aiming to capture their supportive care needs and experiences.

Methods: Fifty-two community members, including survivors and caregivers, participated across 15 group workshops and 20 individual interviews. Sample size was determined through concurrent data collection and analysis. During workshops, participants provided feedback regarding the design, wording and layout of a standard invitation letter typically used in registry-based study recruitment. Principles for designing study invitation materials were then identified through content analysis of workshop transcripts. Using these principles, the research team revised the invitation materials. The acceptability of the revised materials was tested through the interviews.

Results: Based on consumer feedback, study invitation materials (an invitation letter and a flyer) were created. In the interviews, these invitation materials were found to be acceptable to community members. Eleven principles for designing invitation materials were identified from the consumer consultations: (i) communicate empathy and sensitivity; (ii) consider appropriate timing for participation request; (iii) convey credibility and legitimacy; (iv) facilitate reciprocal benefit; (v) include a ‘human element’; (vi) increase accessibility and ease of participation; (vii) optimise readability; (viii) promote inclusivity; (ix) provide reassurance around privacy; (x) encourage participation through a call to action; and (xi) support informed decisions.

Conclusions: Through active and repeated consultation with community members, this study developed study invitation materials that were acceptable and relevant to community members. The principles identified in this study can be used by other researchers to develop invitation materials that are sensitive to the needs and preferences of community members to optimise participation in cancer research.

409 | A systematic review of wearable digital technology use for physical fitness and function assessments in older adults diagnosed with cancer

David Brereton¹, Irene Blackberry¹, Stephen Cousins¹, Christopher Steer¹, Tshepo Rasekaba¹

¹John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga, VIC, Australia

Aims: Geriatric assessment, including physical fitness and function (PFF), is crucial for informing care decisions and enhancing patient-centred care. However, due to workforce shortages, especially in rural and remote contexts, assessment of PFF can be challenging to implement in geriatric oncology practice.

This review seeks to investigate the feasibility, clinical utility, and implications of using wearable digital technology for at-home PFF assessment of older adults diagnosed with cancer in rural and remote areas.

Methods: A systematic literature search was performed in CINAHL, MEDLINE, SPORTDiscus, and Web of Science for English language publications from the previous 10 years investigating the use of wearable digital technology for assessment of PFF in older adults. Two reviewers will independently perform title and abstract screening, full article review and data extraction. Study inclusions are older adults (65+ years) and devices measuring physiologic or kinetic data. Case studies, systematic reviews, conference proceedings, grey literature, and studies covering bespoke or non-portable devices shall be excluded.

Data extraction includes basic article metadata, participant details, assessment details, and outcomes, device validity and reliability, and qualitative feedback on device use.

A realist synthesis framework will be used to identify context-mechanism-outcome patterns, followed by thematic analysis to understand the effective elements of the devices and use in the assessment of PFF in older adults.

Results: Work on this review is currently underway with extraction and analysis of search results (N = 4762) expected by early October.

Conclusions: Physical fitness and functional assessments are important in cancer care; however, implementation remains a challenge, warranting consideration of home-based digital solutions. The findings of this review will present evidence for the use of digital assessments in older populations and the implications this has for geriatric oncology, whilst informing the selection of a suitable wearable digital device for further research in rural and remote geriatric oncology services.

410 | Effectiveness of telehealth versus face-to-face appointments in identifying complications following breast cancer surgery

Ella Buckeridge¹, Leonie Ortlipp¹, Sarah Milne¹

¹Monash Health, Cranbourne, VIC, Australia

Introduction: Breast cancer-related lymphoedma is a common complication post-breast cancer surgery, with early identification of risks and intervention critical. The COVID-19 pandemic necessitated the conversion of many outpatient post-operative surveillance clinics to telehealth. To evaluate the effectiveness of this mode of delivery, the aim of this prospective cohort study was to compare the identification of complications during telehealth appointments versus face-to-face appointments. Client satisfaction was also examined.

Methods: Fifty-six females diagnosed with breast cancer and attending a breast surgery pre-admission clinic attended two modes of assessment: telehealth and face-to-face, 2–7 days apart, within four weeks post-surgery. The following complications were assessed as present or not: scar healing, infection, shoulder range of motion (ROM), cording, swelling and pain. An online satisfaction survey was completed after each appointment. Observed agreement and Gwet's AC1 coefficients were used to examine the agreement in complication identification between modes of assessment. A priori agreement coefficient of ≥80% was deemed clinically acceptable.

Results: Agreement between telehealth and face-to-face appointments met the criteria for acceptability for: scar healing (AC1 coefficient 0.98, 95%CI 0.94–1.00), infection (0.96, 95%CI 0.90–1.00) and shoulder ROM (0.95, 95%CI 0.87–1.00). However, swelling (0.59, 95%CI 0.36–0.82), cording (0.71, 95%CI 0.51–0.90) and pain (0.79, 95%CI 0.63–0.95) did not meet this criteria. Eighty-nine percent (n = 39/44) and 97.7% (n = 43/44) of participants agreed or strongly agreed they would use telehealth again, and it was convenient for them to attend via telehealth, respectively. Sixty-seven percent (n = 34/51) of participants preferred the face-to-face appointment.

Conclusion: Telehealth appointments were accurate in identifying complications related to scar healing, infection and ROM early post-breast cancer surgery; however, further work is required to accurately detect swelling, cording and pain complications during this mode of appointment. Clear reasons for discrepancies can be addressed. This will ensure people following breast cancer surgery can access convenient and efficient care.

411 | A methodology to prioritise digital health solutions for national care pathways for people with pancreatic cancer

Kara Burns¹, Kit Huckvale¹, Carrie Van Rensburg¹, Chathurika Palliya Guruge¹, Cecily Gilbert¹, Gail Garvey², Melanie Lovell³, Isabel E Young³, Kylee Bellingham⁴, Jennifer Philip^4,5,6, Georgia Christopolous⁴, Mei Krishnasamy⁷

¹Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, Australia

²Indigenous Health Research, Univeristy of Queensland, Brisbane, QLD, Australia

³Palliative Care, HammondCare, Greenwich, NSW, Australia

⁴Medicine, University of Melbourne, Parkville, VIC, Australia

⁵Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, VIC, Australia

⁶St Vincent's Hospital, Fitzroy, VIC, Australia

⁷School of Nursing, University of Melbourne, Parkville, VIC, Australia

Aims: This work, commissioned by Cancer Australia to support implementation of priorities under the National Pancreatic Cancer Roadmap, developed prioritised recommendations, from all currently available technologies, that facilitate the implementation and widespread adoption of pain management and palliative care pathways for people with pancreatic cancer. This describes the use of evidence summaries and stakeholder engagement to achieve project aims.

Methods: Evidence summaries (ES) are ‘a synopsis that summarises existing international evidence on healthcare interventions’ and provides key information from research to assist policy and practice-level decisions. ES were developed using literature, opinions of pancreatic cancer experts and interviews with health IT professionals. Information was charted using the Consolidated Framework for Implementation Research and synthesised to develop evidence summaries. The final step included engaging with stakeholders using ES to develop recommendations.

Results: Eleven evidence summaries, demonstrating eleven technologies were then presented to clinician, consumer, culturally and linguistically diverse (CALD), and Aboriginal and Torres Strait Islander stakeholder groups. After consultation, ten digital health technologies were prioritised and recommended to achieve project aims. The technologies identified included: telehealth to improve communication about and service access to pain management and palliative care for regional, remote and priority groups; SMS reminders to improve preparation and attendance at appointments; My Health Record to upload key pain management and palliative care documents for better care coordination; standardising pain electronic patient reported outcome measures; eReferrals for improved referral uptake; development of a national pancreatic cancer clinical registry to evaluate variations in adherence to pain management pathways; patient-facing digital advance care planning; electronic medical record optimisation and digital visual pain tools and automating language translation for CALD patients.

Conclusion: Evidence summaries and stakeholder engagement can be executed rapidly when systematic or scoping reviews are not feasible and can inform digital technology policy recommendations for people with pancreatic cancer.

412 | The effect of the COVID-19 pandemic on the use of telehealth in cancer care: A multi-centre study

Jiawang Cao¹, Andrew O. Parsonson^2,3,4, Gui Xiong^5,6, Mei Ling Yap^1,5,7,8

¹School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

²Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, NSW, Australia

³Clinical Trials Unit, Macquarie University Hospital, Macquarie University, NSW, Australia

⁴Department of Medical Oncology, Nepean Cancer Care and Wellness Centre, Kingswood, NSW, Australia

⁵South Western Sydney Local Health District, Liverpool, NSW, Australia

⁶Ingham Institute, Liverpool, NSW, Australia

⁷Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute UNSW Sydney, Liverpool, NSW, Australia

⁸The George Institute for Global Health, UNSW Sydney, Barangaroo, NSW, Australia

Aim: The COVID-19 pandemic resulted in a rapid uptake of Telehealth use for outpatient consultations in cancer care. The aim of this study was to evaluate the factors associated with the use of telehealth in South Western Sydney Local Health District (SWSLHD) during and after the restrictions of the COVID-19 pandemic.

Methods: Data was obtained from the SWSLHD Radiation Oncology Virtual Clinical Quality Registry for patients who had a specialist appointment between January 2018 and June 2024 across four cancer centres. Descriptive statistics were used to describe patterns of telehealth use and regression analyses were used to assess factors associated with telehealth utilisation.

Results: There were 273,082 outpatient consultations identified for 21,125 unique patients. The use of telehealth (phone or video consultations) peaked during COVID19 restrictions in 2021 with 26% of all consultations being conducted over Telehealth, that reduced to 8% of all encounters in 2023 and 2024. For all consultations: 53% of patients were female, 42% were aged over 70, 65% were married, 8% required an interpreter and 28% had advanced stage disease. Factors associated with higher telehealth use included consultations with female patients (OR 1.11, 95% CI 1.08–1.13, p < 0.001) and patients residing in non-metropolitan (OR 1.43, 1.39–1.48, p < 0.001) or socio-economic advantaged areas (OR 1.39, 1.33–1.46, p < 0.001). Factors associated with lower Telehealth use were consultations with patients who never married (OR 0.92, 0.89–0.95, p < 0.001), required an interpreter (OR 0.54, 0.51–0.57, p < 0.001) or were born overseas in a non-English-proficient country (OR 0.79, 0.77–0.81, p < 0.001).

Conclusion: There is reduced but sustained use of Telehealth in outpatient cancer care services beyond the COVID19 pandemic. Although Telehealth is a useful adjunct to in-person modes of care delivery, it remains comparatively underutilised in populations who experience disadvantage. Initiatives and policies to help reduce disparate use of Telehealth in cancer care are required.

413 | Experiences of patients and clinicians before and after implementation of video telehealth workflows in cancer services: An observational study

Neha Chandrasekar¹, Kevin Zhang¹, Kim Tam Bui¹

¹Concord Repatriation General Hospital, Concord, NSW, Australia

Aim: To evaluate the use and experiences of patients and clinicians before and after implementing structured video telehealth workflows in outpatient cancer services at an Australian tertiary hospital during the COVID-19 pandemic.

Methods: Video telehealth usage data was collected from before and after implementation of structured workflows. Surveys using 5-point Likert scales and open-ended questions assessed participants’ satisfaction, logistics, challenges, and preferences regarding video telehealth. Descriptive analysis was conducted for quantitative responses, while content thematic analysis was used for qualitative responses.

Results: Data was collected between October 2020 and December 2021. Video telehealth usage increased from 15.1% of appointments before to 38.8% after implementation of structured workflows. One hundred and seventy-eight survey responses were received (patients: 136, clinicians: 42). Patients had high satisfaction with video telehealth experience (4.54 ± 0.81). Over half of patients (58.1%) valued the decreased need to travel. Clinicians felt video telehealth was appropriate in certain circumstances (4.48 ± 0.51) and preferred it to telephone telehealth (4.01 ± 0.67). Clinician satisfaction with video telehealth increased post-implementation of structured workflows (before: 3.06 ± 0.34; after: 3.98 ± 0.45). Thematic analysis of patient responses indicated that video telehealth was helpful for routine check-ups and test result reviews. Patients reported improved healthcare access, convenience, and safety, particularly due to the reduced risk of COVID-19 transmission. Clinician responses indicated challenges around technical difficulties and initial resistance to change. Video telehealth was considered less ideal than face-to-face reviews when physical examinations were required, or when addressing specific cultural, language, or emotional needs.

Conclusion: Implementation of structured workflows increased video telehealth use in outpatient cancer services, enhanced access, convenience, and safety for patients, and improved efficiency for clinicians. Further refinement of workflows will minimise logistical barriers and improve user experiences.

414 | Understanding oesophagogastric cancer care in Gippsland 2023: A retrospective analysis of optimal care pathway challenges and supports

Hieu Chau¹, Audrey Nakagawa², Quan Tran¹, Mahesh Iddawela¹

¹Latrobe Regional Hospital, Traralgon, VIC, Australia

²School of Rural Health, Monash University, Melbourne, VIC, Australia

Introduction: Oesophagogastric cancer is associated with a poor prognosis with 5-year survival rates at 23% for oesophageal cancer and 38% for gastric cancer.¹ The Gippsland region has a significantly lower 5-year survival rate compared to the national average 2. The ‘Optimal Care Pathway for People with Oesophagogastric Cancer’ (OCP)4 is a national guideline that defines the best course of care for patients with oesophagogastric cancer. This study aims to examine the disparities between the care provided and the OCP timelines within the current care system.

Method: A retrospective review was conducted on patients with oesophagogastric cancer using data extracted from the existing Gippsland Cancer Redcap Database over the 2023 calendar year. Collection of patient data primarily focused on clinical timeframes, including time of referral to commencement of first treatment. In addition, patient information including demographic characteristics, clinical variables and circumstances at the point of referral to treatment were recorded.

Results: A total of 28 patients with sufficient data for analysis were identified. Preliminary findings indicate that only 65% of these patients achieved the two-week target for completing workup staging in preparation for MDM presentation. The main delays were in the time from referral to completion of staging. Time from complete staging to first treatment times were usually within the 14 day time frame. Data collection and analysis are ongoing and expected to be completed by September 2024.

Conclusion: Preliminary analysis highlights significant challenges in meeting OCP timelines. The significant delays to diagnosis and staging were mainly due to; limited access to medical specialist and diagnostics procedures not available in the region and lack of cohesive coordination of patient appointments at different healthcare providers

Addressing these challenges will require a multi-faceted approach. An oesophagogastric cancer coordinator may help by streamlining appointments and procedures between healthcare providers.

References:

1. Australian Institute of Health and Welfare. Cancer data in Australia [Internet]. Australian Institute of Health and Welfare. 2022 [cited 2024 May 27]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/about

2,. Australian Bureau of Statistics. 2021 Latrobe – Gippsland, Census All Persons QuickStats | Australian Bureau of Statistics [Internet]. www.abs.gov.au. 2021 [cited 2024 Jun 5]. Available from: https://www.abs.gov.au/census/find-census-data/quickstats/2021/205

3. Oesophagogastric Cancer Summit Data Presentation. Victorian Integrated Cancer Services; August 2016. [cited 2024 Jun 5]. Available from: https://www.tumoursummits.org.au/_files/ugd/7ef662_f354795d6cea46c5a9da5f0188d4032b.pdf

415 | What factors influence advance care planning uptake among culturally and linguistically diverse populations?

Ashfaq Chauhan¹, Margo Van Poucke², Mashreka Sarwar³, Thit Tieu^3,4, Ursula Sansom-Daly^5,6,7, Elizabeth Manias⁸, Reema Harrison¹

¹Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia

²Macquarie University, North Ryde, NSW, Australia

³CanEngage Consumer Co-facilitator Network, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia

⁴Sisters Cancer Support Group, Wollongong, NSW, Australia

⁵Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, UNSW Sydney, NSW, Australia

⁶Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia

⁷Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia

⁸Monash University, Clayton, Victoria, Australia

Aim: Low uptake of advance care planning (ACP) with people from culturally and linguistically diverse (CALD) backgrounds when compared to non-CALD populations diminishes the opportunity for person-centric care among this population. While there are number of resources available to support CALD communities that aim to promote ACP uptake, limited impacts have resulted. We undertook a nationwide study to understand barriers and enablers experienced by healthcare staff and interpreters involved in ACP with people from CALD backgrounds with cancer.

Method: A qualitative study was conducted with healthcare staff and interpreters who provided care to people from CALD backgrounds with cancer in a cancer or a palliative care service in Australia for more than six months. Audio-recordings were transcribed. Data analysis was conducted employing the Framework Analysis Method using the theoretical domains framework to understand implementation factors.

Results: Eight focus groups (28 participants) and three individual semi-structured interviews were conducted. Four themes were developed, along with an underpinning theme of interprofessional collaboration in ACP. The four themes were: (1) skills of the healthcare staff and interpreters to undertake ACP and work together; (2) knowledge of cultural factors that impact ACP; (3) physical environment and the care setting in which ACP is conducted; and (4) availability of resources (staff, ACP related documents and time for consultation) to conduct ACP.

Conclusion: A key contributor to ACP with people from CALD backgrounds appears to be the extent of interprofessional collaboration between clinicians and interpreters in communicating about the future wishes of people with cancer when language support is required. Shared understanding of the communication approach, terminologies and how to use the available resources together may support their effective use towards increased uptake of ACP. Identification of mechanisms to foster interprofessional collaboration in ACP communication with CALD communities may support enhanced ACP uptake and person-centric care.

416 | Developing guiding principles for enhancing participation of culturally and linguistically diverse consumers in cancer systems and services consumer engagement activities

Ashfaq Chauhan¹, Bronwyn Newman¹, Reema Harrison¹

¹Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia

Aim: Consumer engagement principles developed by Cancer Australia and other national and state level health departments highlight importance of involving people from culturally and linguistically diverse (CALD) backgrounds in their consumer engagement activities. However, there is very little reference to how these principles apply or should be considered in relation to CALD communities. This research aimed to develop a set of guiding principles to fill this gap.

Method: A modified two-round Delphi consisting of a workshop and two consensus surveys was conducted. Through a workshop with range of stakeholders, an initial set of statements as proposed guiding principles were generated. These statements underwent two rounds of online voting by eligible participants to reach consensus. Quantitative data was analysed using a statistical software. Qualitative feedback was thematically analysed and integrated through discussion between the project team members.

Results: An initial set of 22 statements were developed as proposed guiding principles through the workshop activity. Sixty-five eligible participants completed the first round of survey. Of the 22 statements, 19 received the minimum required score of 70% agreement as relevant to be considered for the next round. Following qualitative thematic analysis and team discussion, a set of 11 statements were produced and distributed for the final round of consensus survey. The 11 statements covered key areas of determining the scope and nature of consumer participation in engagement activities, resourcing, meeting language and other support requirements and evaluating the process employed for engagement for continuous improvement.

Conclusion: The guiding principles complement the existing consumer engagement frameworks and strategies and could be applied to a range of settings including in cancer care to enhance participation of CALD consumers in engagement activities. In doing so, they will create equitable opportunities for CALD consumers to contribute towards health systems and service planning, design and evaluation.

418 | Clinical and socio-demographic profiles of patients referred to the psycho-oncology outpatient clinic at a Victorian regional hospital

Saji S.J. Chathanchirayil¹, Debby Darmansjah¹

¹Goulburn Valley Area Mental Health Services, Shepparton, VIC, Australia

Clinical and socio-demographic profiles of patients referred to the psycho-oncology outpatient clinic at a Victorian regional hospital.

Methods: We reviewed all patients (n = 108) who attended GV Health Psycho-oncology clinic since its inception in February 2017 until February 2023.

419 | Enhancing regional clinical trial recruitment: A multidisciplinary approach

Gemma Downs¹, Michelle Pryce¹, Jhodie Duncan¹

¹Latrobe Regional Health, Traralgon, VIC, Australia

Aims: Multidisciplinary meetings (MDM) foster collaboration among healthcare professionals and provide an avenue to promote equity for regional patients by improving access to clinical trials. This study aims to assess whether MDM can serve as a platform for identifying appropriate clinical trials for patients, as well as identifying barriers and enablers to accessing a clinical trial in regional Victoria.

Method: We conducted a retrospective review of all patients discussed at cancer specific MDM, hosted by a large regional health service, over a 2-year period (June 2022 to June 2024). Data was collected focusing on those patients identified as eligible for clinical trials and tracking their subsequent enrolment to trials, either locally or at metropolitan centre, capturing the reasons for declining participation where stated.

Results: Over the 2-year period, a total of 2,421 patients were discussed and of these, 150 patients were identified as eligible for a clinical trial. Subsequently, 32 patients were successfully enrolled in a clinical trial: 20 (62%) were enrolled in an active trial within our Clinical Trial Unit, and 12 (37%) were recruited to a trial conducted at a metropolitan health service. Travel, demand on time and regular trips to a metro centre were the primary reasons noted for declining trial participation, especially when offered at a metro location.

Conclusions: This study emphasises the significant role MDM play in identifying patients eligible for clinical trials. However, the study also highlights numerous barriers that regional patients encounter when trying to access clinical trials. It was noted that there was improved uptake to trials if they were offered locally. Continued efforts to address these barriers are essential to improve patient access to advanced treatment options and increase recruitment success to ensure equity in care, irrespective of location.

420 | A national cross-sectional survey of community and key informant views, attitudes and preferences for risk-tailored population-based melanoma screening

Kate L.A. Dunlop^1,2, Amelia K. Smit^1,2, Rehana Abdus Salam¹, Gillian Reyes-Marcelino¹, Caroline Watts¹, Rachael L. Morton³, Nicole M. Rankin⁴, Anne E. Cust^1,2

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

²Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

³NHMRC Clinical Trials Centre, Health Economics and Health Technology Assessment, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

⁴Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

Background: In Australia, skin checks primarily occur opportunistically, and are often consumer initiated. A risk-tailored, organised approach to skin cancer screening may reduce inequities and improve cost-effective quality care, and the Government has announced a Roadmap to build the evidence.

Aim: This study aimed to gather nationally representative and stakeholder views on the potential implementation of risk-tailored population melanoma screening.

Methods: From March to May 2024, an online questionnaire was completed by 74 key informants (policy experts, health professionals, researchers and consumer advocates) and 355 members of the community. Questions determined satisfaction with current melanoma early detection, risk assessment approaches, risk-tailored recommendations, research priorities, and open-ended items. Quantitative items were analysed descriptively, and content analysis was used for open-ended items.

Results: Only 25% (community) and 12% (key informants) were satisfied with the current situation of melanoma early detection. Comments highlighted concerns about current and potential future inequitable access to skin cancer early detection services, particularly for regional and remote areas, and health professional workforce availability. Most community participants and key informants agreed with an online questionnaire for the initial risk assessment (78%; 79% respectively), and total body photography as part of a screening examination was supported by the majority (87%; 75% respectively). For people at lower-than-average risk, 72% (community) and 62% (key informants) agreed with offering less frequent screening, however, only 12% and 36% respectively agreed with not offering routine screening to this group. Top priorities for future research included a screening trial of important outcomes and refining the diagnostic test for melanoma screening.

Conclusion: These findings of community and key informant views, attitudes and preferences will guide implementation strategies for a potential future risk-tailored melanoma screening program.

421 | Achieving consensus on instruments for use in the lung cancer rehabilitation core outcome set: An International Delphi study (UNITE)

Lara Edbrooke^1,2, Tom Davies^3,4, Bronwen Connolly⁵, Linda Denehy^1,2

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

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

³William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK

⁴Adult Critical Care Unit, Royal London Hospital, London, UK

⁵Wellcome-Wolfson Institute for Experimental Research, Queen's University Belfast, Belfast, UK

Aims: Using Delphi methodology we developed a core outcome set for evaluation of lung cancer rehabilitation in clinical practice. Core outcomes included physical function, health-related quality of life (HRQoL), breathlessness, emotional and mental wellbeing, activities of daily living, and pain.¹ The aim of this study was to gain consensus on a single instrument to measure each outcome.

Methods: An international Delphi consensus study involving consumers, healthcare professionals, and researchers. For each core outcome, measurement instruments with established psychometric properties were identified from our preliminary overview of reviews.² Participants rated each instrument's importance over two survey rounds. Consensus criteria included ‘retain instrument’ if >70% of participants rated it ‘critical to include’ and <15% rated it ‘not important’. Online consensus meetings ratified survey findings through discussion and voting on the inclusion of instruments rated ‘critical to include’ by >50% of participants.³

Results: Sixty participants from 20 countries were involved. Twenty-one instruments were included in round 1, with an additional eight added in round 2. Consensus was achieved after two survey rounds on use of the six-minute walk test (6MWT) and the European Organisation for Research and Treatment of Cancer core questionnaire (EORTC-QLQ-C30) to measure physical function and HRQoL, respectively. Ten participants attended an online consensus meeting. Following discussion and voting, no further consensus was achieved on instruments to measure the remaining core outcomes.

Conclusions: Measurement instruments were agreed for evaluating physical function and HRQoL in lung cancer rehabilitation. Although the EORTC-QLQ-C30 also includes items for breathlessness, emotional and mental well-being, and pain, consensus was not reached for measurement of these outcomes with this instrument. When evaluating outcomes that did not reach consensus we recommend clinicians choose valid patient-reported measures which are feasible to complete within clinical practice.

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

References:

1. Edbrooke, L, Granger, CL, Francis, JJ, et al. Development of a lung cancer rehabilitation core outcome set: an International Delphi Study (UNITE). J Thor Oncol. 2023;18(11):pS62. doi.org/10.1016/j.jtho.2023.09.055.

2. Edbrooke, L, Bowman, A, Granger, CL et al. Exercise across the lung cancer continuum: an overview of systematic reviews. J Clin Med. 2023;12(5):1871. doi.org/10.3390/jcm12051871

3. Edbrooke, L, Granger, CL, Francis, JJ, et al. Rehabilitation outcomes for people with lung cancer (UNITE): protocol for the development of a core outcome set. BMJ Open Respir Res. 2023;10(1):e001571. doi: 10.1136/bmjresp-2022-001571

422 | The cost-effectiveness of targeted germline BRCA testing in localised prostate cancer followed by cascade testing of first-degree relatives of mutation carriers

Srinivas Teppala¹, Paul Scuffham¹, Kim Edmunds², Matthew Roberts³, David Fairbairn⁴, David Smith⁵, Lisa Horvath⁶, Haitham Tuffaha²

¹School of Medicine & Dentistry, Griffith University, Nathan, QLD, Australia

²Centre for the Business and Economics of Health, University of Queensland, St. Lucia, QLD, Australia

³UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, QLD, Australia

⁴Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, QLD, Australia

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

⁶Oncology, Chris O’ Brien Liifehouse, Camperdown, NSW, Australia

Aims: Prostate cancer (PCa) is highly heritable and one-half of associated pathogenic variants are in the BRCA genes. Genetic testing is recommended in localised PCa patients with elevated risk of mutations and in all patients with metastatic PCa (mPCa). The economics of genetic testing in mPCa has been evaluated previously, however, the value of testing patients with localised PCa has not been assessed. In this context we examined the cost-effectiveness of germline BRCA testing in localised PCa patients with high-risk of mutations with and without the inclusion of cascade testing of first-degree relatives (FDRs) of mutation carriers.

Methods: Cost-utility analysis of germline BRCA testing in localised PCa patients with (1) high/very high-risk PCa staging; (2) family history of PCa; (3) Ashkenazi-Jewish ancestry. Analyses were performed from an Australian payer perspective using semi-Markov multi-health-state transition models with a lifetime time horizon. Decision uncertainty was characterized using probabilistic analyses.

Results: The incremental cost-effectiveness ratio (ICER) of BRCA testing compared to no testing was AU$591,408/QALY in high/very high-risk PCa staging, AU$3.9 million/QALY with a family history of PCa and AU$650,098/QALY in Ashkenazi-Jews. Extension of testing to FDRs resulted in ICERs of AU$18,872/QALY in high/very high-risk PCa, AU$47,294/QALY with a family history of PCa and AU$14,637/QALY in Ashkenazi-Jews. Probability of cost-effectiveness at a willingness-to-pay of AU$75,000/QALY was 0% in the patient-level analyses and 100% in most cascade testing scenarios.

Conclusion: Germline BRCA testing may not be cost-effective in localised PCa patients with a high-risk of mutations but demonstrates value for money when extended to blood related family members of variant-positive patients.

423 | Navigating the dual role of healthcare professional and researcher in a cancer clinical trial: A scoping review

Joseph Elias^1,2, Rachel Baffsky¹, Carolyn Mazariego¹, Jordana McLoone^2,3, Christina Signorelli^2,3, Skye McKay¹, Claire E. Wakefield^2,3, Richard J. Cohn^2,3, Natalie Taylor¹

¹School of Population Health, UNSW Medicine & Health, Ranwick, NSW, Australia

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

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

Aims: Cancer clinical trials frequently report poor implementation outcomes, failing to meet recruitment targets or complete altogether. Healthcare professionals (HCPs) act as brokers between research and practice, playing a critical role in accelerating trial implementation. We conducted a scoping review to (1) identify the core processes involved in delivering cancer clinical trials, (2) determine the extent to which clinical and research roles/responsibilities overlap or are differentiable, and (3) explore factors influencing success of the dual HCP-researcher role in clinical trial and healthcare delivery.

Methods: We searched peer reviewed articles in PubMED and Embase and screened articles against predefined criteria. Population included any trained HCP, context limited to hospital/cancer centre settings undertaking clinical trials, and concepts related to HCPs’ trial experiences. Data extraction occurred in five steps: (1) extracting general study characteristics, (2) developing/refining a clinical trial process map to identify priority target behaviour areas (TBAs), (3) deductive thematic analysis using the Consolidated Framework for Implementation Research encompassing the theoretical domains framework, (4) inductive thematic analysis, and (5) generating implementation strategies using the Expert Recommendations for Implementing Change and Behaviour Change Techniques.

Results: 4656 titles/abstracts were screened, 114 full texts assessed and 47 articles were included. Priority TBAs and respective barriers included: (1) General trial administration (lack of stable funding; limited workforce infrastructure including staffing levels, and dedicated research supports; time constrained by clinical load; lack of training and informational support; unclear roles and responsibilities), (2) Recruitment and consent (concerns that trials interfere/disrupt patient care; rigid/complex study protocols; difficulties determining patient suitability), (3) Randomisation (difficulties maintaining clinical equipoise), and (4) Administering intervention (challenges managing patients’ expectations; treatment toxicities).

Conclusions: Our scoping review provides a critical evaluation of the challenges faced by HCPs managing research and patient care. Knowledge gained will help to inform tailored strategies to address potential role conflicts.

424 | Implementation of digital oncology module for cancer therapy with closed-loop medication management and bedside scanning

Shevon S. Fernando¹, Linda Shi¹, Uyen Hua¹, John Coutsouvelis¹, Caitlin Mcdonald-York¹, Jarrod Donovan¹, Caylen Duncan¹, Erica Tong¹, Michael Dooley¹

¹Alfred Health, Melbourne, VIC, Australia

Background: Prior to implementation of the digital oncology module into the electronic medical record (EMR), cancer therapy orders and administration were documented on paper charts, introducing the risk of transcription errors. In addition, cancer therapy could not be scanned at the bedside by nursing staff on administration.

Objective: To describe the successful implementation of a digital oncology module in a quaternary hospital with a closed-loop medication management system, therefore eliminating handwritten orders, requirement for transcription and introducing scanning of cancer therapy at the bedside.

Method: Digitisation involved creation of standardised doses for each cancer medication to enable bed side scanning, building approximately 2500 order sets, 476 treatment plans, and 486 regimens into our EMR. This encapsulated all standard of care therapy provided at our institution. Education to all cancer clinical staff was provided to ensure the correct workflow was followed for efficient and safe treatment of our patients. Scheduling of therapy was also integrated into treatment plans to streamline bookings for day oncology. Bedside scanning was implemented to ensure accurate administration and facilitates real-time tracking and verification of cancer medications from prescription to administration.

Evaluation: Following the first month (Feb 2024) of digital oncology module implementation, 90% of medications were scanned at the bedside. There were no reported incidents on the hospital risk registry of ordering and administration of incorrect doses or requirement to revert to paper charting.

Discussion: The hospital has successfully digitised cancer therapy prescribing, ordering and administration processes into the EMR. Pivotal was the introduction of a closed-loop medication management system. Through bedside scanning, we achieved comprehensive medication loop closure, enhancing patient safety and operational efficiency. The initiative encompasses the integration of scheduling directly into treatment plans, hence streamlining workflow processes. It's impact on optimisation of resource allocation and improving patient care coordination will be investigated further.

425 | Outcome of metastatic, radioactive-iodine refractory differentiated, medullary and anaplastic thyroid carcinoma – A single institution's experience

Bella Nguyen¹, Zheng Fong¹, Richard Gauci^2,3, Jo Keyser¹

¹Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia

²Department of Endocrinology, Fiona Stanley Hospital, Perth, Western Australia, Australia

³Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia

Background: There is a growing incidence of thyroid cancer (TC). Whilst TC largely has good prognosis, treatment of patients who have metastatic radioactive iodine refractory differentiated TC (RAIR DTC), metastatic medullary TC and anaplastic TC remains challenging. Given relative rarity of these conditions, real world outcomes can be informative in assisting clinicians to make treatment decisions. This poster explores the outcome of different treatments for metastatic RAIR DTC, metastatic medullary TC and anaplastic TC at a single institution.

Method: Patient electronic medical records were reviewed to retrospectively retrieve the patient's clinical details. Clinicopathological data were collected including molecular characteristics, lines of treatments, and time of disease progression and death.

Results: The study included 23 patients. Of these, 16 have metastatic RAIR DTC, four with metastatic medullary TC, and three with anaplastic TC. In the metastatic RAIR DTC group, overall response rate (ORR) to lenvatinib is 89%, with median progression free survival (PFS) not reached, but exceeding that of 20 months. Most common side effects were consistent with those reported in the SELECT trial, however 89% ended up with dose reduction and treatment breaks. Four patients in this group underwent redifferentiation with BRAF & MEK inhibitor or a MEK inhibitor alone, and 3 out of 4 showed successful redifferentiation response. All metastatic medullary patients were found to have RET mutations and responded to RET-inhibitors. Of the three anaplastic TC patients, one had BRAF V600E mutation and showed complete response to BRAF & MEK inhibitor. Another anaplastic TC patient had complete and sustained, long term response following combination of pembrolizumab and lenvatinib.

Conclusion: Our study showed real world data of patients with RAIR DTC, metastatic medullary TC, and anaplastic TC with promising real-world response rate to lenvatinib, redifferentiation therapy, RET inhibitors, long-term response to BRAF & MEK inhibitor combination and immunotherapy with lenvatinib combination.

427 | The upper gastrointestinal cancer registry – Using real world data to examine quality indicators of care in oesophagogastric cancers

John Zalcberg^1,2, Liane Ioannou², Bronwyn Brown², Elysia Greenhill², Benjamin Brown², Eileen Lam², Wendy Brown^1,2

¹Alfred Health, Melbourne, VIC, Australia

²Monash University, Melbourne, VIC, Australia

Aims: The Upper Gastrointestinal Cancer Registry (UGICR) is a multi-modular clinical quality registry based at Monash University. The aim of the registry is to collect real-world data to identify unwarranted variation in treatment and outcomes for people diagnosed with upper gastrointestinal cancers; by looking at quality of care indicators (QIs). These QIs cover various parts of a patient's care pathway including referral, diagnosis, surgical management, medical management, and end-of-life care. This study investigated the variation in QIs in UGICR participants from the oesophagogastric module.

Methods: The UGICR collects participants through an opt out approach, with patients identified through hospital administration data or state cancer registry. Data collectors then review medical records and enter data into the UGICR's REDCap database. Data from adult patients recruited through the UGICR, and diagnosed with an oesophagogastric cancer between 2016 and 2023, at 13 participating sites in Victoria, Australia, were used to examine QIs. Only patients that had been diagnosed and received some treatment at the same hospital were included, to ensure more complete data collection.

Results: The dataset included 1669 UGICR participants, predominately male (69%), with oesophageal, junctional or gastric cancers. QIs were examined by calculating the proportion of patients meeting each quality indicator. Some QI's had high adherence, and low variability such as histology before treatment (94.9%), and proportion of patients with metastatic cancer who were seen by a medical or radiation oncologist (100%). Other indicators related to surgery (e.g., number nodes examined), or palliative care, demonstrated more variance and lower adherence and require further investigation.

Conclusions: The oesophagogastric module of the UGICR has significant participant recruitment across Victoria and continues to expand. In addition to providing a means to detect variation in quality of care, the UGICR's whole population capture makes it an ideal platform for registry-based trials and biobanks.

428 | Different patterns of care and survival outcomes in transplant-centre managed patients with early-stage HCC: Real-world data from an Australian multi-centre cohort study

Jonathan Abdelmalak^1,2,3, Simone Strasser⁴, Natalie Ngu⁴, Claude Dennis⁴, Marie Sinclair³, Avik Majumdar³, Kate Collins³, Katherine Bateman³, Anouk Dev⁵, Joshua Abasszade⁵, Zina Valaydon⁶, Daniel Saitta⁶, Kathryn Gazelakis⁶, Susan Byers⁶, Jacinta Holmes^7,8, Alexander Thompson^7,8, Dhivya Pandiaraja⁷, Steven Bollipo⁹, Suresh Sharma⁹, Merlyn Joseph⁹, Rohit Sawhney^10,11, Amanda Nicoll^10,11, Nicholas Batt¹⁰, Myo Tang¹, Stephen Riordan¹², Nicholas Hannah¹³, James Haridy¹³, Siddharth Sood¹³, Eileen Lam², Elysia Greenhill², Liane Ioannou², John Lubel^1,2, William Kemp^1,2, Ammar Majeed^1,2, John Zalcberg^1,2, Stuart Roberts^1,2

¹Alfred Health, Melbourne, VIC, Australia

²Monash University, Melbourne, VIC, Australia

³Gastroenterology, Austin Hospital, Melbourne, VIC, Australia

⁴AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

⁵Gastroenterology, Monash Health, Melbourne, VIC, Australia

⁶Gastroenterology, Western Health, Melbourne, VIC, Australia

⁷Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia

⁸Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia

⁹Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW, Australia

¹⁰Gastroenterology, Eastern Health, Melbourne, VIC, Australia

¹¹Medicine, Eastern Health Clinical School, Melbourne, VIC, Australia

¹²Gastroenterology, Prince of Wales Hospital, Randwick, NSW, Australia

¹³Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia

Management of early-stage hepatocellular carcinoma (HCC) is complex with multiple treatment strategies available. We performed this real-world multi-centre cohort study in two liver transplant centres (LTCs) and eight non-transplant centres (NTCs) across Australia to assess for variation in patterns of care and key survival outcomes.

Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC, first diagnosed between 01 January 2016 and 31 December 2020 who were managed at a participating site were included in the study. Patients were excluded if they had a history of prior HCC or if they received upfront liver transplantation.

A total of 887 patients were included in the study, with 433 patients managed at LTC and 454 patients managed at NTC. Management at a LTC did not significantly predict allocation to resection using multivariable binary logistic regression adjusting for tumour burden as well as age, gender, liver disease aetiology, liver disease severity and medical comorbidities (adjusted OR 0.75 95%CI 0.50–1.11, p = 0.148). However, in those not receiving resection, LTC and NTC patients were systematically managed differently, with LTC patients five times less likely to receive upfront ablation than NTC patients (adjusted OR 0.19, 95%CI 0.13–0.28, p < 0.001). LTC patients had significantly higher proportions of patients undergoing TACE for every tumour burden category, including those with single tumour 2 cm or less (p < 0.001). Forty-two of 887 patients (4.7%) underwent transplantation during follow-up, with higher Charlson Comorbidity Index (CCI) in LTC patients who received liver transplant compared to NTC patients (median 5 vs. 3, p = 0.028). Using multivariable Cox−proportional hazards analysis, management at a transplant centre was associated with reduced all−cause mortality (adjusted HR 0.71, 95%CI 0.51–0.98, p = 0.036) and competing−risk regression analysis considering liver transplant as a competing event demonstrated a similar reduction in risk (adjusted HR 0.70., 95% CI 0.50–0.99, p = 0.041).

429 | Initial trans-arterial chemo-embolisation (TACE) is associated with similar survival outcomes as compared to upfront percutaneous ablation in those with single hepatocellular carcinoma (HCC) ≤ 3 cm: Results of a real-world propensity-matched multi-centre Australian cohort study

Jonathan Abdelmalak^1,2,3, Simone Strasser⁴, Natalie Ngu⁴, Claude Dennis⁴, Marie Sinclair³, Avik Majumdar³, Kate Collins³, Katherine Bateman³, Anouk Dev⁵, Joshua Abasszade⁵, Zina Valaydon⁶, Daniel Saitta⁶, Kathryn Gazelakis⁶, Susan Byers⁶, Jactina Holmes^7,8, Alexander Thompson^7,8, Dhivya Pandiaraja⁷, Steven Bollipo⁹, Suresh Sharma⁹, Merlyn Joseph⁹, Rohit Sawhney^10,11, Amanda Nicoll^10,11, Nicholas Batt¹⁰, Myo Tang², Stephen Riordan¹², Nicholas Hannah¹³, James Haridy¹³, Siddharth Sood¹³, Eileen Lam¹, Elysia Greenhill¹, Liane Ioannou¹, John Lubel^1,2, William Kemp^1,2, Ammar Majeed^1,2, John Zalcberg^1,2, Stuart Roberts^1,2

¹Monash University, Melbourne, VIC, Australia

²Alfred Health, Melbourne, VIC, Australia

³Gastroenterology, Austin Hospital, Melbourne, VIC, Australia

⁴AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

⁵Gastroenterology, Monash Health, Melbourne, VIC, Australia

⁶Gastroenterology, Western Health, Melbourne, VIC, Australia

⁷Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia

⁸Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia

⁹Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW, Australia

¹⁰Gastroenterology, Eastern Health, Melbourne, VIC, Australia

¹¹Medicine, Eastern Health Clinical School, Melbourne, VIC, Australia

¹²Gastroenterology, Prince of Wales Hospital, Randwick, NSW, Australia

¹³Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia

Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤ 3 cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation.

Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3 cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study.

A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank test p = 0.652) or liver-related survival (log-rank test p = 0.495) over a median follow up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs. 56%, p < 0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs. 80% p = 0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival was similar (log rank test p = 0.355 and p = 0.390 respectively).

Our study provides valuable real-world evidence that TACE when offered with appropriate follow up treatment is a reasonable initial management strategy in very-early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed in this area.

430 | Improved survival outcomes with surgical resection compared to ablative therapy in early-stage HCC: A large, real-world, propensity-matched, multi-centre, Australian Cohort study

Jonathan Abdelmalak^1,2,3, Simone Strasser⁴, Natalie Ngu⁴, Claude Dennis⁴, Marie Sinclair³, Avik Majumdar³, Kate Collins³, Katherine Bateman³, Anouk Dev⁵, Joshua Abasszade⁵, Zina Valaydon⁶, Daniel Saitta⁶, Kathryn Gazelakis⁶, Susan Byers⁶, Jacinta Holmes^7,8, Alexander Thompson^7,8, Dhivya Pandiaraja⁷, Steven Bollipo⁹, Suresh Sharma⁹, Merlyn Joseph⁹, Rohit Sawhney^10,11, Amanda Nicoll^10,11, Nicholas Batt¹⁰, Myo Tang², Stephen Riordan¹², Nicholas Hannah¹³, James Haridy¹³, Siddharth Sood¹³, Eileen Lam¹, Elysia Greenhill¹, Liane Ioannou¹, John Lubel^1,2, William Kemp^1,2, Ammar Majeed^1,2, John Zalcberg^1,2, Stuart Roberts^1,2

¹Monash University, Melbourne, VIC, Australia

²Alfred Health, Melbourne, VIC, Australia

³Gastroenterology, Austin Hospital, Melbourne, VIC, Australia

⁴AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

⁵Gastroenterology, Monash Health, Melbourne, VIC, Australia

⁶Gastroenterology, Western Health, Melbourne, VIC, Australia

⁷Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia

⁸Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia

⁹Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW, Australia

¹⁰Gastroenterology, Eastern Health, Melbourne, VIC, Australia

¹¹Medicine, Eastern Health Clinical School, Melbourne, VIC, Australia

¹²Gastroenterology, Prince of Wales Hospital, Randwick, NSW, Australia

¹³Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia

The optimal treatment approach in very-early and early-stage hepatocellular carcinoma (HCC) is not precisely defined, with ambiguity in the literature around the comparative efficacy of surgical resection versus ablation as curative therapies for limited disease. We performed this real-world propensity-matched, multi-centre cohort study to assess for differences in survival outcomes between those undergoing resection and those receiving ablation.

Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC first diagnosed between 01 January 2016 and 31 December 2020 who received ablation or resection as initial treatment were included in the study.

A total of 450 patients were included in the study from 10 major liver centres including two transplant centres. Patients who underwent resection were systematically different to those who received ablation, with significant differences seen in age, managing centre, liver disease aetiology, diabetes, platelet count, Charlson Comorbidity Index (CCI) tumour burden and Child Pugh score, Propensity-score matching was performed using key covariates producing 156 patients available for analysis with 78 in each group. Over a median follow up of 53.3 months, patients who underwent resection had significantly improved overall survival (97.4% vs. 88.5%, log-rank test p = 0.023) with similar results in the original unmatched cohort (94.9% vs. 83.9%, log-rank test p < 0.001). Local recurrence-free survival was superior in the resection group (88.5% vs. 76.7%, log-rank test p = 0.027) over a median follow-up of 37.9 months with similar superior 3-year recurrence-free survival (75.6% vs. 57.5%, log-rank test p = 0.007). Major complication rate was low in the original unmatched resection group who had been selected for surgery by a real-world multidisciplinary group of expert clinicians (two out of 196, 1.0%).

Our study suggests that surgical resection results in more durable local tumour control in BCLC 0/A HCC as compared to ablation which translates to improved survival outcomes.

431 | End-of-life healthcare service utilisation and costs for first nations people with cancer: A data linkage study from Queensland Australia

Shafkat Jahan¹, Ming Li¹, Gail Garvey¹

¹The University of Queensland, Herston, QLD, Australia

Aims: Cancer represents a significant health burden for First Nations people, with higher incidence and lower survival rates, emphasising the necessity for culturally safe End-of-life (EOL) care. However, there is limited understanding of EOL service use and associated costs for First Nations People. Therefore, this study aims to provide a comprehensive assessment of EOL healthcare service utilisation and costs for a statewide cohort of First Nations people diagnosed with cancer.

Methods: We utilised retrospective data from CancerCostMod, a linked administrative dataset containing all cancer diagnoses in Queensland, Australia, as reported by the Queensland Cancer Registry (QCR) from 1 July 2011 to 30 June 2015. This data was linked to Queensland Health's Admitted Patient Data Collection (QHAPDC), Emergency Department Information Systems (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data from 1 July 2011, to 30 June 2018. We conducted descriptive analyses followed by Mann–Whitney or Kruskal–Wallis tests (p < 0.05) to assess health service use, associated costs during the last 6 months of life (EOL), and variations across different factors.

Results: Among the 467 deaths analysed, on average, each person had five hospital episodes (range: 1–49), primarily in public hospitals (86%). Nearly all individuals had at least one MBS or PBS claim (96%). Over 80% had at least one Emergency Department (ED) visit, and almost 50% had three or more visits. Individuals receiving palliative care and chemotherapy had higher hospital, MBS, and PBS claims and associated costs. Younger patients with comorbidities incurred greater government costs for hospital and ED care. Patients aged 65 and older had lower out-of-pocket PBS costs. Rural patients had higher hospital costs but lower ED and PBS costs.

Conclusions: The findings underscore the significant burden on healthcare systems during EOL, emphasising the need for innovative and culturally sensitive approaches to alleviate this burden.

432 | Recommendations to enhance the rigor of stepped-wedge trials in oncology research: Findings from a systematic review

Hannah Jongebloed¹, Anna Chapman¹, Skye Marshall¹, Liliana Orellana², Victoria White³, Trish Livingston^1,4, Anna Ugalde¹

¹Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia

²Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia

³School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia

⁴Faculty of Health, Deakin University, Geelong, VIC, Australia

Aims: Cancer-related stepped-wedge cluster-randomised trials (SW-CRTs) need to be rigorous to deliver impactful trial outcomes and support effective translation into practice. This review examined design features and protocol deviations, methodological rigor, and implementation aspects of SW-CRT designs in oncology settings and developed recommendations for future trials.

Methods: A systematic review was conducted, searching five databases (MEDLINE Complete, CINAHL Complete, PsycINFO, Embase and CENTRAL) in July 2023. Studies using a SW-CRT design in an oncology setting were eligible. Records were screened using Covidence. Intervention characteristics, design features, protocol deviations, statistical approach, implementation strategies, and outcomes were extracted, coded, and evaluated narratively.

Results: The search yielded 3395 unique records with 25 publications reporting on 15 trials (n = 8 efficacy trials; n = 7 implementation trials) testing diverse interventions in healthcare settings. Common protocol deviations included changes to trial duration (n = 7; 47%), number of planned clusters (n = 4; 27%) and secondary outcomes (n = 4; 27%). Despite implementation outcomes being reported in 14 (93%) trials, 12 (86%) did not use an established evaluation framework to guide the selection and reporting of implementation outcomes. Results indicate a need for investment into accurate recruitment projections given the challenges of expanding sites or extending timelines, accurate and clear reporting, and acknowledging and reporting on any deviations to a published protocol or study registration. When resourcing allows, trials should measure both implementation and clinical outcomes and adopt best-quality implementation science methodology to guide any future implementation.

Conclusions: SW-CRTs provide a valuable design for testing efficacy and implementation of complex healthcare interventions in the oncology setting. Trials should aim to be proactive in managing the risks associated with executing the SW-CRT design and for methodology to be reported rigorously according to guidelines. Taking a strategic approach can enhance the design and impact of SW-CRTs, leading to improved patient outcomes and advancements in cancer care.

434 | Molecular tumour boards: The Australian consortium experience

Lama Karroum¹, Sudi Shrestha¹, Mark Shackleton^1,2,3,4,5, Melissa C. Southey^1,6,7

¹MPCCC, Monash Partners Comprehensive Cancer Consortium, Clayton, VIC, Australia

²Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Clayton, VIC, Australia

³Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, VIC, Australia

⁴Victorian Heart Institute, Monash University, Clayton, VIC, Australia

⁵Department of Clinical Pathology, The Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia

⁶School of Translational Medicine, Monash University, Melbourne, VIC, Australia

⁷Department of Oncology, Alfred Health, Melbourne, VIC, Australia

Introduction: The emergence of precision medicine has revolutionised oncology, particularly in cancer therapeutics, where comprehensive molecular sequencing data is utilised to tailor individualised treatments for patients. Molecular Tumour Boards (MTBs) are central to this approach, providing multidisciplinary forums for experts to analyse data and formulate personalised treatment plans.

Impact of MTBs on Treatment Decisions: MTBs significantly impact treatment decisions by improving diagnostic accuracy, staging processes, and adherence to clinical guidelines.

MPCCC Molecular Tumour Boards: The Monash Partners Comprehensive Cancer Consortium (MPCCC) established its MTB series in 2018. The MTBs involve comprehensive reviews of molecular screening reports and evidence-based treatment recommendations. More recently, the MTBs at MPCCC have undergone a major operational change to enhance efficiency, impact, and reach guided by the Leavitt's diamond model addressing process, people, and technology elements.

Operational Model Changes: Key changes include: Governance Structure: Implementing a robust governance framework with clear roles and streamlined communication to enhance decision-making. The MPCCC Fellows Network: A distinctive feature of the MPCCC MTBs is the Molecular Oncology and Pathology Fellows Network, promoting collaboration and knowledge exchange, offering real-time information on clinical trials and therapeutic options, improving communication among clinicians. MTB Operations Meetings: Preparatory meetings that precede MTBs to triage cases and connect clinicians with national and international cancer researchers. This MPCCC model of operation is unique in comparison to other MTB models from around the world, especially the experience of cancer consortiums and alliances, placing a strong emphasis on connection, equity of access and education.

Conclusion: The MPCCC experience with MTBs exemplifies the transformative potential of multidisciplinary collaboration in precision oncology. By integrating Molecular Oncology and Pathology Fellows into the MTB framework, MPCCC fosters innovation, enhances clinical care, and drives advancements in cancer research. Continued investment in infrastructure, workforce development, and data sharing initiatives will maximise impact on patient outcomes.

435 | Exploring opportunities to improve supportive service provision for oncology patients undergoing chemotherapy treatment: A secondary analysis of a randomised controlled trial

Bora Kim¹, Chantale Boustany², Judith Fethney³, Judy M. Simpson⁴, Kate White²

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

²Cancer Care Research Unit, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

³School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia

⁴School of Public Health, Sydney University, Camperdown, NSW, Australia

Aims: To examine the common reasons for and potential risk factors associated with unplanned presentations (UPs) in oncology patients undergoing chemotherapy treatment.

Methods: The presentation will cover the analysis of longitudinal data from a randomised controlled trial involving adult oncology patients undergoing the first three cycles of chemotherapy at two tertiary hospitals in Sydney, Australia. UPs, such as emergency department visits and unscheduled cancer centre visits, were included in the analysis. Descriptive statistics were used to report the prevalence of and common reasons for UPs. Poisson regression was used to explore sociodemographic and clinical factors associated with UPs. Multivariable analysis was conducted with variables with p < 0.2 in univariate analysis.

Results: Analyses included data from 346 patients with a mean age of 59 (range 24–97), of whom 223 (64%) were female, 169 (49%) had stage 4 cancers and 145 (42%) had curative intent treatment. 115 patients (33%) made 144 UPs, with most making one (n = 91, 79%) UP and the rest (n = 24, 21%) making more than one UP. Of 144 UPs, 67 (46%) were made during cycle 1, and 81 (56%) were chemotherapy-related. The predominant reasons were fever with/without neutropenia (n = 50, 35%) and nausea/vomiting (n = 30, 21%). Fifty-two percent (n = 75) of UPs did not result in hospital admission. Of the 346 patients, 70 (20%) had hospital admissions, with median length of stay 3 days (IQR 2–7). Multivariable analysis identified the following as factors associated with UPs: cancer stage (stage 1 vs. stage 4: IRR 2.50, 95% CI: 1.28–4.89; p = 0.01) and cancer type (lung cancer vs. breast cancer: IRR 2.25, CI: 1.26–4.01; p = 0.01).

Conclusions: Supportive care provision during chemotherapy may be most beneficial during the first treatment cycle, when most UPs occurred. A high proportion of direct discharges from the emergency department indicates opportunities for reducing UPs through primary or outpatient-based care.

436 | Common reasons and risk factors for within 28 days acute hospital utilisations post colorectal cancer surgery

Bora Kim¹, Judith Fethney², Margaret-Ann Tait³, Claudia Rutherford², Kate White³

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

²School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia

³Cancer Care Research Unit, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

Aims: To examine the prevalence and common reasons for emergency presentation/hospital readmission within 28-days following colorectal cancer surgery and identify their possible predictors.

Methods: We analysed routinely collected de-identified data containing patient demographics, comorbidities, surgical procedures, and acute hospital utilisations from three major metropolitan hospitals in Sydney, NSW. Data for adult patients (>18 yrs) admitted to these hospitals for a colon/or rectum surgical procedure with concurrent colorectal cancer diagnosis between 1 January 2015 and 30 July 2020 were included. Prevalence and reasons for within 28-day post-surgical emergency presentations and hospital admissions were reported descriptively. Poisson regression of sociodemographic and clinical data was used to explore risk factors for emergency department (ED) presentations. Multivariable analysis was conducted with variables with p < 0.1 in the Chi-Squared test.

Results: Analyses included data from 1653 patients; mean age 67 (range 19–98), male (n = 945, 57%), colon cancers (n = 1166, 71%), married (n = 987, 60%), and having English as primary language (n = 1233, 75%). 193 patients (12%) made 237 ED presentations: 155 patients (65%) made one, and 82 patients (35%) made more than one presentation. Half of ED presentations (n = 106, 45%) were made within 10 days post-surgical discharge. Predominant reasons were gastrointestinal symptoms and surgical complications (n = 100, 42%), infection or wound-related (n = 60, 25%), and volume depletion and electrolyte imbalance (n = 26, 11%). Of 1653 patients, 156 (9%) made 163 hospital admissions, with a median length of stay of 5 days (IQR 3–12). Multivariable analysis identified the following factors associated with ED presentation: stoma versus no stoma: 0.71, 95% CI: 0.53, 0.96; p = 0.026) and pre-operative malnutrition versus no malnutrition: 0.51, 95% CI: 0.3,0.86; p = 0.013).

Conclusions: One in ten colorectal post-surgical patients had ED presentations within 28-days of hospital discharge. There may be opportunities to reduce such episodes through better infection control and nutritional support interventions.

437 | This is Me: Revision of a co-designed resource to communicate what matters most to older adults with cancer when treatment decisions are being considered

Nicole Kinnane¹, Catherine Devereux¹, Paul Baden², Marilyn Dolling³, Christopher Steer^4,5,6, Amit Khot^7,8, Donna Milne^9,10, Aileen Wilkinson¹¹, Trish Joyce⁸, David Gyorki^7,9,12, Alexander Heriot^7,11,12, Mei Krishnasamy^1,2,10

¹Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

²VCCC Alliance, Melbourne, Victoria, Australia

³Independent Consumer Advocate, Melbourne, Victoria, Australia

⁴Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury Wodonga, NSW, Australia

⁵UNSW School of Clinical Medicine, UNSW Rural Clinical Campus, Albury, NSW, Australia

⁶John Richards Centre for Rural Ageing Research, La Trobe University Wodonga Campus, Wodonga, Victoria, Australia

⁷Sir Peter MacCallum Dept of Oncology, The University of Melbourne, Melbourne, Victoria, Australia

⁸Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia

⁹Skin and Melanoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

¹⁰Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

¹¹Lower GI Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

¹²Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: Determining what matters most to older adults with cancer is integral to delivery of age-friendly care. Although international evidence demonstrates substantial benefits of doing so, this does not happen routinely in practice.¹ This is Me (TiM) is a novel Australian co-designed self-report tool addressing functional/physical/emotional health; comorbidities; cognition; social inclusion; preferences for quality or quantity of life; It enables older adults to communicate with their cancer team about what matters most to them.

Aims: Prior to dissemination of TiM resource for use in routine practice, we consulted older adults to revise wording and content to ensure it is fit for purpose.

Methodology: A qualitative study using semi-structured interviews. Eligible consumers (patients/carers) were recruited from Melanoma, Multiple Myeloma (MM), Lower Gastrointestinal (LGI) services at a tertiary cancer centre. Modified Cognitive Interviewing techniques (CI) of verbal probing and think aloud approaches^2–4 explored interpretation of each resource item. Data were analysed using qualitative manifest content analysis to inform resource revision.

Results: Ten consumers (4 MM/6 LGI) participated across two rounds of CI (nine patients/one carer). Words identified with most ambiguity were diet and medications. The time frame ‘In the last six months’ regarding possible events, for example, falls/weight loss was considered too lengthy. Response options in the ‘What's important’ domain required refinement to indicate more clearly its focus on what matters most to people. Instructions for completing TiM, including how the information could be used, were recommended.

Conclusion: TiM items were refined to align with consumer preferences and intent of the resource. Brief instructions were developed to support its use in practice. Further research is warranted to determine feasibility of TiM to prompt discussion of what matters most to older adults in clinical contexts. A national survey is underway exploring multidisciplinary cancer clinicians’ views of TiM as a component of usual care.

References:

1. Laderman M, Jackson C, Little K, et al. What matters to older adults? A toolkit for health systems to design better care with older adults; 2019.

2. Beatty PC, Willis GB. Research synthesis: the practice of cognitive interviewing. Public Opin Quart. 2007;71(2):287-311.

3. Willis GB, Artino Jr AR. What do our respondents think we're asking? Using cognitive interviewing to improve medical education surveys. J Grad Med Educ. 2013;5(3):353-356.

4. Wolcott MD, Lobczowski NG. Using cognitive interviews and think-aloud protocols to understand thought processes. Curr Pharm Teach Learn. 2021;13(2):181-188.

438 | Meaningful and effective consumer involvement in cancer care: Recommendations for optimal co-design

Nicole Kiss¹, Hannah Jongebloed², Brenton J. Baguley¹, Skye Marshall², Victoria M. White³, Trish M. Livingston², Kathryn Bell⁴, Leonie Young⁴, Sabe Sabesan⁵, Dayna Swiatek⁶, Anna Boltong⁷, Joanne M. Britto⁸, Anna Ugalde²

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

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

³School of Psychology, Deakin University, Burwood, Victoria, Australia

⁴Consumer representative, Clinical Oncology Society of Australia, Sydney, NSW, Australia

⁵Department of Medical Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia

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

⁷Kirby Institute, University of New South Wales, Sydney, NSW, Australia

⁸Victorian Comprehensive Cancer Centre Alliance, Parkville, Victoria

Aims: Co-design refers to active engagement with stakeholders in the development of an initiative. Although the benefits of consumer engagement in research and healthcare initiatives are known, there is a need to optimise this for all people affected by cancer. This study co-designed recommendations to guide the application of optimal co-design in oncology research, practice, and policy, underpinned by a systematic literature review.

Methods: An expert stakeholder group was formed, including consumers, senior representatives from key oncology organisations in Australia who have led national initiatives on consumer participation in healthcare, and researchers with strong consumer engagement in their research programs. Stakeholders were involved in: (1) developing the review protocol, (2) reviewing a draft list of recommendations generated from the review, and (3) workshopping to explore review results and discuss draft recommendations. Workshop feedback was organised into themes to refine the recommendations followed by two further rounds of consultation with stakeholders.

Results: Themes that emerged were: (1) methodological issues, including inconsistent reporting and use of frameworks, inconsistent consideration of power dynamics, and inconsistent engagement of consumers; (2) co-design participation issues, including limited rationale for the choice or diversity of consumers and other stakeholders, and limited reporting of consumer recognition such as renumeration or authorship; (3) evaluation issues, including poor reporting of evaluation of the co-design process and the co-designed initiative limiting assessment of factors influencing the effectiveness or uptake of co-designed initiatives. From these themes, nine recommendations were developed relating to co-design methodology, recruitment and engagement of consumers and other stakeholders, and evaluation of co-design initiatives.

Conclusions: Co-design is an important and increasingly used methodology for engaging people affected by cancer in the development of cancer control initiatives. The recommendations generated guide researchers, clinicians, health services, government policy makers and consumer advocacy organisations to meaningfully and robustly utilise co-design processes.

439 | Implementing evidence-based care for older adults with lung cancer: A 12-month report of an innovative nurse-led model of care

Nicole Knox¹, Shalini Vinod^1,2,3, Katie Knight², Victoria Bray², Elise Tcharkhedian², Josephine Campisi², Gemma McErlean^1,4, Meera Agar^2,5, Louise Hickman¹

¹University of Wollongong, Wollongong, Australia

²SWSLHD, Liverpool Hospital, UK

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

⁴Center for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia

⁵IMPACCT, University of Technology Sydney, Sydney, NSW, Australia

Background: Despite evidence supporting the benefits of geriatric screening and assessment for older adults with cancer, specialised geriatric oncology programs in Australia remain limited. Multimorbidity and geriatric syndromes are prevalent among this population, and supportive services beyond cancer-specific treatment are critical to providing optimal person-centred cancer care. Innovative models of care are essential to address growing healthcare demand and disparities.

Aim: To implement and evaluate a nurse-led model of care for screening and assessing geriatric needs in older adults with lung cancer.

Method: A nurse-led geriatric oncology model of care was co-designed with key stakeholders, including consumers. A nurse used validated tools to screen and assess all new patients with lung cancer aged 65+ or 50+ for Aboriginal and Torres Strait Islander peoples. Based on the assessment, a pathway of care included nursing referrals to allied health and specific triggers identifying those needing a multidisciplinary geriatric assessment. Patients were subsequently discussed at a multidisciplinary team meeting, with a letter generated to the patient's GP.

Results: Over 12 months, 100 patients were assessed by the nurse. The median age was 73.5(range 65–87). Of the 89 patients who had treatment, 70(79%) were seen prior to, 5(6%) were seen on the day of, and 14(16%) were seen after commencement of treatment. The most frequently reported issues included polypharmacy (40%), depression(18%), mobility(18%), and cognition (12%). Patients were referred to allied health in 78% of cases, while 7% were referred to a Geriatrician via their GP. All patients were discussed at the nurse-led MDT meeting and received a follow-up call at 4–6 weeks. Patients surveyed reported high satisfaction/acceptability, with 98% expressing positive feedback.

Conclusion:Innovative nurse-led models of care increase evidence-based care for older adults with cancer. This intervention provides workflow processes for screening and assessment of geriatric syndromes that can be tailored to health services worldwide.

440 | ‘They didn't really care what I ate, they just said eat food’. Exploring the nutrition-related experiences and preferences of adolescents and young adults with cancer

Erin Laing^1,2,3, Nina Axelsen¹, Sophie L'Estrange⁴, Madison Hille⁵, Andrew Murnane⁶

¹Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

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

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

⁴Nutrition & Food Services Department, Royal Children's Hospital, Melbourne, VIC, Australia

⁵Nutrition & Dietetics, Monash Health, Melbourne, VIC, Australia

⁶Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Aims: Cancer among adolescent and young adults (AYA) is rare but significant, with these years crucial for physical and social development, and building a sense of autonomy. Cancer nutrition is well-studied in paediatric and older adult populations, however the nutritional status and needs of AYA are relatively unknown. This study aimed to explore the nutrition-related experiences, needs and nutrition service engagement of AYA with cancer.

Methods: This was an exploratory sub-study of the multi-site AYCANN (AYa CANcer Nutrition) project. All eligible AYA (15–25 years, on or within 6-months of cancer treatment) at paediatric and adult health services in Victoria were invited to participate in virtual focus groups or interviews. Purposive sampling was undertaken to ensure heterogeneity among participants. Coding was undertaken by two independent researchers, using a deductive approach (coding against key questions), followed by an inductive approach (identify recurring themes).

Results: Sixteen AYA from five health services participated across five focus groups and two interviews (mean 21yrs, 63% male, 75% at adult hospital). Various cancer diagnoses were represented (lymphoma n = 6, sarcoma n = 5, brain n = 2, testicular n = 2, leukaemia n = 1). Key themes included ‘change in weight and physical appearance’, ‘eating to survive/cope’ and ‘value of one-on-one care’. Participants spoke about treatment-related weight change (loss and/or gain) and its negative effects on body image and identity. ‘Eating to survive/cope’ with a focus on consuming high energy/fat and convenience foods was common. AYA valued early nutrition information/support after their cancer diagnosis and described one-to-one care from a dietitian as most valued. Family played a key role in supporting receipt of nutrition information for AYA <18yrs of age.

Conclusions: Early and targeted one-on-one nutrition information/support is highly valued among AYA with cancer. Findings from the AYCANN project will aid establishment of nutrition guidelines and optimal models of nutrition care for AYA in Victorian cancer services.

441 | The development of a pain needs assessment tool for people with pancreatic cancer

Melanie Lovell¹, Isabel Young¹, Gail Garvey², Mei Krishnasamy³, Gregory Crawford^4,5, Nicole Rankin⁶, Farwa Rizvi⁷, Georgia Christopoulos⁷, Kara Burns⁸, Kylee Bellingham⁷, Jennifer Philip^4,9,10

¹Palliative Care, HammondCare, Greenwich, NSW, Australia

²Indigenous Health Research, Univeristy of Queensland, Brisbane, QLD, 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

⁷Medicine, University of Melbourne, Parkville, VIC, Australia

⁸Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, Australia

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

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

Aims: To develop a Pain Needs Assessment Tool for national application for people with Pancreatic Cancer on behalf of Cancer Australia. The tool must effectively provide people living with pancreatic cancer a screening questionnaire to ensure the presence of pain is communicated to health professionals.

Methods: A systematic literature review was undertaken of pain assessment tools used in cancer pain management. A Working Group was established comprised of experts (n = 8) in quality-of-life measurement, pancreatic cancer care, primary care, pain medicine and community members from rural, regional and metropolitan areas across Australia to review, refine and develop a draft tool.

Stakeholder groups, including culturally and linguistically diverse community members, Aboriginal and Torres Strait Islander peoples, health professionals and peak bodies representing community members affected by pancreatic cancer, reviewed drafts over a series of four meetings. Through a process of iterative feedback from stakeholder discussions to the Working Groups, findings from literature reviews, local expertise and experience were progressively shaped to produce the outputs. Clinical guidance to support the use of the tool was developed with linkage to the Australian Cancer Pain Management in Adults Clinical Guideline.

Results: The Pain Needs Assessment Tool includes a screening tool with a pain numeric rating scale represented with categorical identifiers, faces and colours; seven questions were included specific to pancreatic cancer pain, information and support needs and side effects of medications. These were accompanied by a body chart. These were associated with clinical guidance for the screening tool and for comprehensive pain assessment for people with pancreatic cancer.

Conclusions: The Pain Needs Assessment Tool is applicable for use in routine care at every clinical encounter as part of the comprehensive care of people with pancreatic cancer.

442 | Establishment of the Peninsula Health Oncology and Supportive Intervention Service (OASIS) – Bridging the gaps to improve care of the older patient living with cancer

Sandra Maciver¹, Joanne Lundy^2,3, Anjali Khushu⁴, Michael Choi⁴, Baheerathan Narayanan⁵, Joan Thomas¹, Rohan White⁶, Zoe Thomas¹

¹Cancer Services, Peninsula Health, Frankston, VIC, Australia

²Department of Oncology, Peninsula Health, Frankston, VIC, Australia

³Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia

⁴Geriatric Medicine, Peninsula Health, Frankston, VIC, Australia

⁵Rehabilitation Medicine, Peninsula Health, Frankston, VIC, Australia

⁶Community Health, Peninsula Health, Rosebud, VIC, Australia

Introduction: Individuals aged 65 years and older represent approximately half of the Peninsula Health (PH) oncology patient population. This cohort is more likely to have pre-frailty/frailty and are at increased risk of systemic therapy intolerance, postoperative complications and mortality. Current guidelines recommend extension of the cancer multidisciplinary team to include geriatric expertise including integration of formal screening/assessment processes to optimise care of older persons with cancer.

Aims: OASIS is a collaborative service aiming to integrate expertise in oncology, geriatrics and rehabilitation medicine into the existing model of care within PH Cancer Services. It aims to optimise care and outcomes for older patients with cancer at all points of the cancer journey, including diagnosis, treatment and survivorship to improve health and resilience in this high-risk cohort.

Model of Care: All patients >65 are screened (G8 tool) and referred into Rehabilitation/Geriatrician clinic dependent on G8 score. A nurse-led clinic conducts pre-clinic assessments including multi-domain Comprehensive Geriatric Assessment. MDT case conferences (with Oncologist, Geriatrician, Rehabilitation Physician, CNC, Allied health) occur within a week of review to formulate individualised care plans/interventions, which are fed back to treating GPs/oncologists. Care delivery is designed to integrate with existing Peninsula Health/external cancer care services.

Results: The service was established in March 2024 with seed funding from a SMICS grant, with projections to be financially self-sustaining from Year 3.

To date, 83 patients have been referred to the service, with 76% referred to the Geriatric Stream (GS) and 24% to the Rehabilitation Stream (RS). The most prevalent interventions were referral to a Cancer Rehab Program (60% GS/83% RS), medication management (50% GS, 33% RS), further investigation (30% GS), other allied health referral (25%), GP review (15%), palliative care (10%), other lifestyle interventions (10%) and the Better@Home Program (5%). The program has been strongly supported by clinicians and patients.

References:

1. Health Information Services Peninsula Health Frankston VIC 3199

2. William Dale et al., Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update. JCO 41, 4293-4312(2023). DOI:10.1200/JCO.23.00933

3. Magnuson A, Dale W, Mohile S. Models of Care in Geriatric Oncology. Curr Geriatr Rep. 2014 Sep;3(3):182-189. doi: 10.1007/s13670-014-0095-4. PMID: 25587518; PMCID: PMC4289627.

4. Garcia MV, Agar MR, Soo W, To T, Phillips JL. Screening Tools for Identifying Older Adults With Cancer Who May Benefit From a Geriatric Assessment: A Systematic Review. JAMA Oncol. 2021;7(4):616–627. doi:10.1001/jamaoncol.2020.6736

443 | Cancer services planning protocol: Implementing strategic planning across a Victorian cancer network

Ashley Macleod¹, Linda Nolte¹

¹North Eastern Melbourne Integrated Cancer Services (NEMICS), Victorian Integrated Cancer Services, Melbourne, VIC, Australia

Background: Strategic planning activities are often at risk of unintended bias and overpoliticisation which can influence the distribution of resources and focus and create inequities across a patient's cancer journey. Embedding equity-centred approaches and data mapping exercises to align priorities with cancer policy into strategic planning activities ensures a broad range of perspectives are given equal weight. This can be achieved by incorporating data collection and data mapping exercises that allow for independent contribution from a diverse range of staff within the business unit.

Aim: To embed equity-centred, evidence-based approaches to the development of a Strategic Plan for a Cancer Service Unit.

Methods: The evaluation of the most recent Cancer Services Plan and the development and publication of an updated Plan will occur across three stages. In Stage 1, an online survey of Cancer Services senior staff will evaluate progress against the most recent Cancer Services Plan and identify all ongoing and incomplete priorities to be included in the updated plan. Stage 2 will consolidate data from Stage 1 and an environmental analysis of the current and future state of cancer care needs and policy for the Cancer Services Unit to produce a longlist of relevant potential priorities and directions for the revised plan. In Stage 3, senior staff will complete another online survey to assess the feasibility and impact of potential priorities. Survey data will be analysed to identify the leading priorities for inclusion in the new Plan. The draft Plan will then be circulated to Cancer Services executives for amendment and approval.

Conclusion: Using an equity-centred approach to strategic planning activities allows priority setting activities to be guided by diverse perspectives from across all aspects of cancer care. This approach will help ensure a more balanced distribution of resources and effort across the Cancer Services Unit.

444 | Implementing an evidenced based model of pre-operative nutrition care in patients undergoing oral cavity reconstruction surgeries for head and neck cancer

Shane McAuliffe^1,2, Sarah Davies¹, Kate White^3,4,5, Jonathan Clark^1,2,6, Merran Findlay^1,3,4,5,7

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

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

³Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

⁴Cancer Services, Sydney Local Health District, Sydney, NSW, Australia

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

⁶Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia

⁷Maridulu Budyari Gumal (SPHERE) Cancer Clinical Academic Group, South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia

Aims: To assess the feasibility of implementing a pre-operative evidence-based nutrition care pathway (EBCP) for patients undergoing oral cavity reconstruction surgery for head and neck cancer (HNC).

Methods: Mixed-methods pre-post study in a retrospective cohort (1 January to 31 December 2023) prior to pilot implementation in a prospective cohort. Pre-implementation audit criteria included pre-admission processes (dietetic referral, nutrition screening and assessment) and clinical outcomes (complications, length of stay (LOS) and readmissions).

A survey of multidisciplinary team (MDT) members explored (i) participant background, (ii) perception of the importance of nutrition, (iii) roles and responsibilities, (iv) barriers to nutrition screening and assessment using the capability, opportunity, motivation-behaviour (COM-B) model.

Quantitative data were analysed using descriptive statistics and qualitative data using summative content analysis.

Results: Patients undergoing oral cavity reconstruction surgery (n = .115; 51% female, median (IQR) age 65 (55,71) yrs) in the study period were included. Nutrition care processes (referral, screening and assessment with a validated tool) were completed for 60%, 91% and 13% of patients respectively. Malnutrition risk was identified in 19%, with false negative screening noted in 22%. Weight loss (0% vs. >10%) was associated with increased LOS (22 vs. 12.5, p = 0.01) and ICU LOS (4.5 vs. 2, p = 0.048) days.

Full survey responses (n = 11) were completed across four disciplines (speech pathology (n = 4), surgeon (n = 3), dietitian (n = 2), and nursing (n = 2)). Most (9/11) recognised the importance of nutrition, however, more than half (7/11) felt the current service does not meet patient's needs. Frequently cited barriers to screening and assessment included resources (n = 9), knowledge (n = 8) and time (n = 7).

Conclusions: Evidence-practice gaps in nutrition care processes were identified, despite nutrition care consistently recognised as a priority. Barriers to nutrition screening and assessment were related to capability and opportunity, rather than motivation. Focus groups will further inform a tailored EBCP for prospective implementation.

445 | Defining capabilities for nurses to provide quality cancer survivorship care in Australia: A modified Delphi approach

Gemma McErlean^1,2, Raymond Chan³, Heidi Hui², Fiona Crawford-Williams³, Nicolas Hart⁴, Thomas Walwyn⁵, Mahesh Iddawela⁶, Rebecca McIntosh⁷, Mei Krishnasamy⁸, Bogda Koczwara³, Michael Jefford⁷

¹University of Wollongong, Wollongong, Australia

²St George Hospital, Kogarah, NSW, Australia

³Flinders University, Adelaide, South Australia, Australia

⁴University of Technology Sydney, Sydney, Australia

⁵Royal Hobart Hospital, Hobart, Tasmania, Australia

⁶Monash University, Melbourne, Victoria, Australia

⁷Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

⁸University of Melbourne, Melbourne, Victoroia, Australia

Aim: Nurses play an important role in the care of cancer survivors. This study aimed to establish capabilities required for nurses to deliver quality cancer survivorship care in Australia.

Methods: A two-round online modified Delphi method, involving Australian cancer nurses, was used. Initial domains and capability items were based on the Quality of Cancer Survivorship Care Framework (Nekhlyudov, 2019) and supplemented by national and international nursing frameworks. In Round 1 (R1), experts categorised 53 capability items according to the National Professional Development Framework for Cancer Nursing (EdCaN) nurse groups of ‘all’, ‘many’, ‘some’, ‘few’ nurses, or not relevant. In Round 2 (R2), experts rated their agreement with these assignments. Respondents could comment on each item in both rounds, and consensus was achieved at 80%.

Results: Surveys were distributed to 51 experts, with a response rate of 92% (47/51) for R1 and 75% (38/51) for R2. Experts had 1–15 years’ experience in cancer survivorship, cared for all age groups (paediatric to geriatrics), worked across the healthcare sector (primary to quaternary care) and 55% had a Masters degree. The 8 domains reviewed included prevention and surveillance for recurrence and new cancers, surveillance and management of physical and psychosocial effects, surveillance and management of chronic medical conditions, health promotion, communication, decision-making, care coordination, and survivor/carer experience. Respondents proposed separating several capabilities in R1, and reworded some for clarity, resulting in 10 new items for R2. In R2, 63 capabilities were presented, with all but 2 reaching consensus. These items moved from ‘many’ to ‘few’ based on free text comments.

Conclusions: This study mapped 63 survivorship capabilities applicable to ‘all’, ‘many’, ‘some’ or ‘few’ Australian cancer nurses. This provides important foundational work to support greater involvement, training, and role clarity of cancer nurses in the care of cancer survivors across Australia.

Reference:

1. Nekhlyudov L, Mollica MA, Jacobsen PB, Mayer DK, Shulman LN, Geiger AM. Developing a quality of cancer survivorship care framework: implications for clinical care, research, and policy. JNCI. 2019;111(11):1120-1130.

446 | Cancer health care professionals’ confidence in referring cancer survivors to exercise support: A qualitative study

Christopher J. McHardy¹, Jia (Jenny) Liu^2,3,4, Roy T.H. Cheung¹, Haryana Dhillon⁵

¹School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia

²The University of Sydney, Camperdown, NSW, Australia

³St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia

⁴The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

⁵Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia

Background: Exercise during active cancer treatment improves cancer survivor (CS) outcomes. However, only 30% of CS achieve exercise guideline recommendations and less than 20% are referred for exercise intervention.

Aims: We explored cancer healthcare professionals (CHCPs) perceptions of their knowledge, skill, and confidence making exercise referrals.

Methods: We conducted a prospective qualitative study. Semi-structured interviews were conducted with CHCPs who were invited via professional groups and snowballing. Interviews were conducted on Zoom, recorded, transcribed and analysed using Interpretative Description methods to facilitate translation into practice. Interviews continued until information power was achieved.

Results: Interviews were conducted with 28 participants (17 oncologists, seven nurses, four surgeons) between April and June 2024. We identified three key themes:

Exercise discussion timing: CHCPs consistently confirmed the value of exercise for CS but were unsure of the optimal timepoint to discuss exercise and which CHCP was primarily responsible. In the absence of a clinical pathway and service, implementation of routine exercise referrals were challenging.

Clinical environment: Appointments early in treatment are too overwhelming for patients to absorb detailed exercise advice. Exercise discussion in follow-up appointments perceived suitable when clinically safe for CS. Survivorship clinics have more time for comprehensive exercise discussions though are not equitably available.

Clinician knowledge: Clinicians perceived having an adequate understanding of aerobic exercise prescription. However, they were less confident in making resistance exercise recommendations and approving a CS as safe to exercise. CHCPs required guidance from ES regarding which information in a referral is useful to them to optimise use of consultation time for both CHCP and ES. Bi-directional communication between exercise providers and referrers would benefit CS care.

Conclusion: CHCP require training in optimal exercise advice to increase confidence in making exercise referrals. A referral pathway to an exercise resource or service may facilitate greater adherence to exercise recommendations and accessibility.

447 | Embedding behaviour change discussion within oncology exercise referral: A qualitative study

Christopher J. McHardy¹, Jia (Jenny) Liu^2,3,4, Roy T.H. Cheung¹, Haryana Dhillon⁵

¹School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia

²The University of Sydney, Camperdown, NSW, Australia

³St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia

⁴The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

⁵Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia

Background: Exercise during cancer treatment reduces treatment-related side effects. However, fewer than 20% of patients are referred for exercise intervention.

Aims: We explored acceptability of a structured exercise referral template aimed at facilitating discussion of exercise behaviours, barriers, and enablers.

Methods: We conducted a prospective qualitative study. A one-page exercise referral form (ERF) was co-designed with cancer healthcare professionals (CHCPs) and exercise specialists (ES). Semi-structured interviews were conducted on Zoom, recorded, transcribed, and analysed using Interpretative Description methods to facilitate translation into practice. Interviews continued until information power was achieved for two separate groups: cancer health care professionals; exercise providers.

Results: CHCPs (n = 28) and ES (n = 8) consented to being interviewed.

The ERF was found comprehensive, though likely time consuming to complete. Nursing staff were considered ideal to complete the ERF given their frequent patient interaction and scope of practice. Oncologists acknowledged the authority imbued within their recommendations, warranting referral by them. Surgeons were not willing to use ERF rather advocating exercise, with their support team completing referrals. Knowledge of chronic disease management funding options and exercise program cost facilitated referral.

CHCPs need training to know what information is valued by ES to optimise consult time for both professional groups. ES requested more cancer treatment details to guide exercise prescription. Behaviour change insights would help optimise ES time across initial assessment and treatment, enabling deeper psycho-social conversations with patients. Both professional groups acknowledged bi-directional communication would benefit exercise knowledge development and patient care.

Conclusion: Behavioural change questions embedded into oncology ERF may prompt deeper exercise discussion and improve patient preparedness for exercise. Identification of an exercise champion within the multidisciplinary team may facilitate team commitment to exercise referrals. Context adapted ERF may increase patient engagement and streamline referral at each respective clinical site.

449 | Comprehensive review of childhood cancer survivors current health concerns through a remote Health and Lifestyle Assessment

Hsu Htun¹, Jordana McLoone^1,2, Christina Signorelli^1,2, Claire Wakefield^1,2, Elysia Thornton-Benko^1,3, Karen Johnston², Rachael Baldwin^1,2, Richard Cohn^1,2

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

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

³Bondi Road Doctors, Bondi, Sydney, NSW, Australia

Aim: Late effects of childhood brain cancer can emerge decades post-treatment cessation. Long-term follow-up care is advised, but barriers to access can lead to disengagement from oncology services. We formulated a self-report, remote health and lifestyle assessment to thoroughly review childhood cancer survivors’ current health concerns across various body systems, psychosocial domains, health behaviours, medication use, and genetic information. This study aimed to evaluate the accuracy, feasibility, and acceptability of this comprehensive assessment tool.

Method: Childhood brain cancer survivors completed the health and lifestyle assessment online. Following completion, a survivorship nurse validated each response during an online telehealth consultation with the survivor (16 categories of body systems; between 137 and 408 items). Concordance between survivor and nurse reports was calculated. At one-month post-intervention, survivors completed a program evaluation survey.

Results: A total of sixty-one survivors (mean age = 21 years; range = 10–41 years) participated. The overall survivor/nurse discordance rate between reports was 10.6%, with the most discordant sections related to hearing (16%), dental (13%), endocrine (13%), and central nervous system (13%). On average, the assessment took 50 minutes for survivors to complete, and 67 minutes for nurses to validate responses during the online consultation. Survivors reported the health and lifestyle assessment to be ‘relevant to their medical care’ (79%), ‘easy to complete’ (88%), and reported that the nurse consultation ‘helpful‘ (97%).

Conclusion: The remote health and lifestyle assessment was highly acceptable to survivors, feasible for clinical implementation, and demonstrated accuracy in assessing survivors’ health concerns. This remote assessment supports a telehealth model for ongoing cancer survivorship care.

450 | Adherence to healthcare recommendations among childhood cancer survivors participating in a distance-delivered survivorship program

Rachael Baldwin^1,2, Joseph Alchin^1,2, Christina Signorelli^1,2, Jordana McLoone^1,2, Claire Wakefield^1,2, Joanna Fardell^1,2, Karen Johnston¹, 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

Aims: Continuous, lifelong survivorship care is vital for childhood cancer survivors (CCS) to address health issues that arise from their treatment, and to improve their quality of life and well-being. Yet, many survivors display sub-optimal levels of adherence to their healthcare provider follow-up care recommendations and advice. The underlying reasons for this are not well understood. This study aimed to adherence to personalized healthcare recommendations among long-term CCS participating in the ‘Re-engage’ program, and investigated factors associated with recall and adherence to recommendations at one- and six-months post-intervention.

Method: As part of the ‘Re-engage’ program, long-term CCS completed a thorough assessment of their cancer-related medical history and review of current health needs by a multidisciplinary team (MDT). Personalized recommendations for health interventions, surveillance, and healthy lifestyle improvements were provided. Survivors’ recall and adherence to these recommendations were evaluated at one and six months post-intervention. Factors associated with recall and adherence were analyzed using univariate negative binomial regressions.

Results: Twenty-five CCS (average age = 31.9 years) participated in the Re-engage program. Each survivor received an average of 6.6 recommendations (range = 1-11). The survivor could correctly recall recommendations at 1-month and 2 recommendations at 6-months post-intervention. At 6-months post-intervention, 56% percent of CCS reported complete non-adherence, and the overall average was adherence to 1.3 recommendations. At 6-months follow-up, better adherence to the MDT's recommendations was associated with a history of second cancer (p < 0.001) and higher levels of worry about late effects (p = 0.002).

Conclusions: The study reveals that recall and adherence to healthcare recommendations among CCS are generally low and sub-optimal. Improving adherence necessitates clear communication of healthcare recommendations, coupled with effective discussion of methods to overcome potential barriers to adherence, and late effects education. These strategies may enhance the health outcomes and quality of life for survivors.

451 | Exercise and cancer program: New models of exercise care for cancer patients in regional areas

Jordan McMillan¹, Mathilda Ohrt¹, Donna O'Callaghan², Renee Jones³

¹Latrobe Community Health Service, Morwell, VIC, Australia

²Gippsland Regional Integrated Cancer Service, Traralgon, VIC, Australia

³Latrobe City Council, Morwell, VIC, Australia

The Exercise and Cancer program in Gippsland was developed to enhance the well-being of oncology patients through structured exercise regimens and support services. The program was started due to limited access to specialised services in the Latrobe Valley region of Gippsland. The multidisciplinary team included exercise physiologists, oncology health professionals, and leisure centre fitness professionals. Initial assessments determined whether patients participated in individual, group sessions, or home-based programs. Key physical outcomes were measured using the 30-s Sit to Stand (STS) test, 3-min step test, and Handgrip test.

Over 15 months, the program received 106 referrals, resulting in 813 episodes of care, including 522 group attendances, 136 individual gym sessions, 74 initial assessments, and 81 reassessments with an exercise physiologist. Outcome measures showed significant improvements: on average a 38.7% overall increase in leg strength (STS), 19.1% and 14.9% increases in right and left handgrip strength, respectively, and a 30.1% increase in aerobic fitness (3-min step test). Additionally, participants experienced an 11% average decrease in depression and a 6% average decrease in fatigue.

Key learnings highlight the program's success in addressing physical challenges and supporting holistic well-being through community and social connectedness. Participants valued the supportive environment, exemplified by feedback such as, ‘I love doing something for my cancer symptoms and not having to go to a hospital.’ Future expansions should prioritise local Leisure Centre champions to maintain the community-centric and inclusive nature of the program.

453 | Factors impacting hospitalisation and related health service costs in cancer survivors in Australia: Results from a population data linkage study in Queensland

Katharina Merollini^1,2, Louisa Collins^3,4, Andrew Jones⁵, Joanne Aitken^6,7, Michael Kimlin⁸

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

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

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

⁴School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia

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

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

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

⁸Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia

Aims: The global economic cost of cancer and ongoing care costs for survivors are increasing. Little is known about factors affecting hospitalisations and related costs for the growing number of cancer survivors. Our aim was to identify contributing factors of cancer survivors admitted to hospital in the public system and their costs from a health services perspective.

Methods: A population-based, retrospective, data linkage study was conducted in Queensland (COS-Q), Australia, including individuals diagnosed with a first primary cancer (1997–2015) and incurred healthcare costs between 2013 and 2016. Generalised linear models were fitted to explore associations between socio-demographic (age, sex, country of birth, marital status, occupation, geographic remoteness category, socio-economic index) and clinical factors (cancer type, year of /time since diagnosis, vital status, care type) with mean annual hospital costs and mean episode costs.

Results: Of the cohort (N = 230,380) 48.5% (n = 111,820) incurred hospitalisations in the public system (n = 682,483 admissions). Hospital costs were highest for individuals who died during the costing period (cost ratio ‘CR’: 1.79, p < 0.001) or living in very remote or remote location (CR: 1.71 and CR: 1.36, p < 0.001) or aged 0–24 years (CR: 1.63, p < 0.001). Episode costs were highest for individuals in rehabilitation or palliative care (CR: 2.94 and CR: 2.34, p < 0.001), or very remote location (CR: 2.10, p < 0.001). Higher contributors to overall hospital costs were ‘diseases and disorders of the digestive system’ (AU$661m, 21% of admissions) and ‘neoplastic disorders’ (AU$554m, 20% of admissions).

Conclusions: We identified a range of factors contributing to hospitalisation and higher hospital costs for cancer survivors and our results clearly demonstrate very high public health costs of hospitalisation. There is a lack of obvious means to reduce these costs in the short or medium term which emphasises an increasing economic imperative to improving cancer prevention and investments in home- or community-based patient support services.

454 | The value of routine COVID-19 rapid antigen test screening in the chemotherapy day unit

Conor Morris¹, Sue-Anne McLachlan¹, Rachel Rosaia¹

¹St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia

Aims: In 2022, with the rise in COVID-19 cases, St Vincent's Hospital Melbourne implemented routine asymptomatic rapid antigen tests (RATs) in the chemotherapy day unit (CDU) to prevent outbreaks and enable early antiviral treatment for cancer patients, who were believed to be at higher risk of severe COVID-19. This study aimed to evaluate the effectiveness of this screening program.

Methods: The patient alert system (PAS) was used to identify confirmed COVID-19 cases among those who had attended the CDU. The medical records were reviewed for each of these patients to identify if the case was screening detected and their resultant outcomes.

Results: 125 positive alerts were identified during 2022. Only 14 of these were screening detected from 4532 eligible episodes of care. Of these, 10 were haematology patients, four were oncology patients. Five patients were on curative intent treatment. Among the 14 cases, five had symptoms, three had significant epidemiological risk factors, and only six were asymptomatic with no risk factors. Severity was mostly mild: three patients needed admission, four had moderate disease, and 10 had mild disease. There were no severe cases or deaths. Twelve patients received antiviral therapy, and nine were referred to the COVID-19 HITH service. Testing cost approximately $12,916, with each test taking 15 minutes of CDU chair time. On average, there was a 26-day delay between a positive test and the next treatment session.

Conclusions: The screening program helped avoid in-centre outbreaks and severe cases of COVID-19 during a high transmission period, with high antiviral uptake. However, it incurred significant time and financial costs, detecting only one case per 324 tests. A more targeted testing approach and a stricter questionnaire might have improved efficiency. Unfortunately this study did not capture false positives which would have caused unnecessary treatment delays.

456 | National guidelines for early detection of breast cancer in younger women – A key to reducing inequity

Carolyn Nickson¹, Louiza S. Velentzis¹, Paul Grogan¹, Bruce Mann², Karen Canfell¹

¹The Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, Sydney, NSW, Australia

²Breast Service, The Royal Women's and Royal Melbourne Hospital, Melbourne, VIC, Australia

Aims: To evaluate the equity and effectiveness of Australian services for the early detection of breast cancer in women under 50.

Methods: We summarised breast cancer burden in women <50, mapped service availability, utilisation and outcomes, and analysed related guidelines and policies.

Results: Around 20% of Australian breast cancers are diagnosed in women <50; incidence has increased by 50% over the last 20 years.¹ Breast cancer is the second-highest disease burden in Australian women aged 40–49,² with poorer relative survival compared to older women.³ Early detection saves lives and reduces treatment intensity.⁴

BreastScreen Australia is available but not targeted to women aged 40–49. Although these services comprise around 10% of BreastScreen episodes, they are not subject to the same level of quality assurance monitoring in place for the target age group (50–74).⁵ As recommended by the ROSA-Breast project,⁶ risk-adjusted entry age may be warranted, noting that many countries start screening at 45 (as per European Breast Guidelines⁷) or age 40 (as per WHO recommendations⁸).

Outside BreastScreen, different guidelines for referring and managing younger women considered at-risk or symptomatic (e.g., RACGP ‘Red Book’, RANZCR statements, eviQ, Medicare Schedule) mean that women's pathways to early diagnosis depend on where they live and who they see, with an overreliance on patient-initiated action and capacity for out-of-pocket costs. Qualitative studies show this generates confusion for clinicians and patients,⁹ and disparities related to health literacy and socio-economic status.

Current health data collection and reporting limits our capacity to assess the population-level clinical and cost effectiveness of available services for early detection of breast cancer in younger women.

Conclusions: National Australian clinical guidelines for the early detection of breast cancer would help reduce inequities for women <50 and increase our capacity to evaluate and make evidence-based improvements to these health services.

References:

1. Australian Institute of Health and Welfare. Cancer data in Australia. Canberra 2023. Available from: www.aihw.gov.au/reports/cancer/cancer-data-in-australia

2. Australian Institute of Health and Welfare & Cancer Australia 2012. Breast cancer in Australia: an overview. Cancer series no. 71. Cat. no. CAN 67. Canberra: AIHW.

3. National Cancer Control Indicators. Relative survival by stage at diagnosis (female breast cancer). Charts. Available from: ncci.canceraustralia.gov.au/relative-survival-stage-diagnosis-female-breast-cancer.

4. Elder K, Nickson C, Pattanasri M, et al. Treatment intensity differences after early stage breast cancer (ESBC) diagnosis depending on participation in a screening program. Ann Surg Oncol. 2018;25(9):2563-2572.

5. Australian Institute of Health and Welfare. BreastScreen Australia Monitoring Report 2023. Data tables. AIHW, 2023. DOI: 10.25816/w6zm-mt86

6. The Daffodil Centre (2023). The ROSA Project – summary. Summary of ‘Roadmap for Optimising Screening in Australia – Breast’, investigating risk-based breast cancer screening. Produced by the Daffodil Centre on behalf of Cancer Council Australia. Available from: www.cancer.org.au/go/rosabreast

7. Schünemann HJ, Lerda D, Quinn C, et al. European Commission Initiative on Breast Cancer (ECIBC) Contributor Group. Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Ann Intern Med. 2020;172(1):46-56. Doi: 10.7326/M19-2125.

8. World Health Organisation. WHO position paper on mammography screening. Accessible via: www.who.int/publications/i/item/9789241507936

9. Collins IM, Steel E, Mann GB, et al. Assessing and managing breast cancer risk: clinicians’ current practice and future needs. Breast. 2014 Oct;23(5):644-50. doi: 10.1016/j.breast.2014.06.014. Epub 2014 Jul 4.

457 | Improving the governance and quality of cancer multidisciplinary meetings (MDMs) at a Victorian cancer network

Sameerah Arif¹, Jesvinder Kaur¹, Stephanie Lawson¹, Claire Rickard¹, Helena Rodi¹, Linda Nolte¹

¹North Eastern Melbourne Integrated Cancer Services, Heidelberg, VIC, Australia

Aim: To improve the governance and quality of cancer MDMs at Northern Eastern Melbourne Integrated Cancer Service (NEMICS) member health services to align with the Victorian Cancer Multidisciplinary Team Meeting Quality Framework (MDM Quality Framework) and principles of Optimal Care Pathways.

Method: From June 2023, NEMICS collaborated with member health services to implement a range of governance and quality improvement strategies. Strategies included establishment or redesign of MDM governance, terms of reference (TOR), membership, revenue, and patient consent and information. Strategies also included improving the capture of the MDM minimum dataset via MDM software, a rapid literature review of MDM streamlining, and monitoring performance via the Victorian Cancer Services Performance Indicator (CSPI) audit.

Results: Four NEMICS member health services with 35 MDMs were included. All member health services now have an MDM governance structure established. Over half of MDMs (92%, n = 34) now have updated TOR in-date with the MDM Quality Framework and 50% of member health services are implementing the National Weighted Activity Unit for revenue and activity counting. One member health service has updated their existing MDM software fields to capture the minimum dataset. Whilst the other three member health services have or are transitioning to MDM software, QOOL-Vic and will capture the minimum dataset. All member health services have updated their MDM patient information resources to support informed patient consent. Rapid literature review results demonstrated MDM streamlining as a possible strategy to address increasing MDM capacity requirements. Implementation of the CSPI audit program continues to measure performance against the MDM Quality Framework and Optimal Care Pathways for health services.

Conclusion: Collaboration between the Integrated Cancer Services and health services can achieve improvements in MDM governance and quality and promote optimal patient care. Future research should examine MDM streamlining implementation within health services.

458 | Complication rates when deaccessing central venous access devices with heparinised saline or sodium chloride locks at a regional network: A retrospective study

Mary R. Nushaj¹, Cherie Seeliger¹, Rajat Rai¹, Susan Moreton¹, Mohsen Shafiei¹, Andrew Jensen¹, Arnav Nanda¹, Florian Honeyball¹

¹Western Cancer Centre Dubbo, Dubbo, NSW, Australia

Aim: The Cancer Institute NSW Central Venous Access Devices (CVADs) deaccess clinical procedure resource suggests locking lines with sodium chloride 0.9%, a deviation from prior standard procedure of the Western Cancer Centre Dubbo (WCCD) to use heparinised saline 50U/5 mL. The aim of this quality improvement project was to investigate complication rates of CVADs during this change in practice.

Methods: All patients attending the infusion suite at the WCCD network in a six week period immediately following the change in procedure in April 2022 were identified. All patients with a CVAD at any time within six months were included. Complications, defined as poor blood return or flow through the CVAD necessitating radiological investigation, were identified by reviewing medical records. Fisher's exact test was performed to compare the incidence of complications in the six months before the change in procedure to 6 months after.

Results: In the six months prior to and following the change in procedure, 287 individual patients attended the WCCD network for infusions. Of these, 112 patients had at some stage had at least one CVAD device (39% of all patients). 134 devices were used through the 12 month study period. Seven out of 90 devices (7.8%) deaccessed using heparinised saline developed a complication, compared to 15 out of 134 devices (11.2%) deaccessed using sodium chloride 0.9%. This difference was not statistically significant (p = 0.495, Fishers Exact test).

Conclusions: The complication rates of CVADs at the WCCD are comparable to those in published data. No significantly statistically significant difference in rates of complications of CVADs were found when changing the procedure, however there was a trend to more imaging of CVADs. Standardising the criteria for pursuing imaging within the region as well as a prospective trial comparing the two procedures are planned.

459 | Implementation of in-home cancer survivorship model of person-centred care for South Gippsland Shire and Surrounds

Donna O'Callaghan¹, Tanya Cook², Kylie Ashton²

¹Gippsland Regional Integrated Cancer Service, Traralgon West, VIC, Australia

²Gippsland Southern Healthcare Service, Leongatha, VIC, Australia

Background: Cancer survivorship needs are increasing as cancer detection and treatment options improve, and our population ages. A lack of survivorship care in South Gippsland limits patient access to post-cancer treatment care.

Aims: Gippsland Southern Health Service (GSHS) aims to enhance health outcomes and treatment experiences for Gippsland cancer patients via implementation of a Survivorship Clinic.

Conclusion: Survivorship clinics in regional Victoria are a necessary component of person-centred cancer care. Offering in-home appointments improved access to survivorship care for those with limited public transport. Linking patients with local supportive care services reduced travel to Melbourne or tertiary health services. Patients reported improvements in support, highlighting the benefits this clinic in the South Gippsland LGA.

460 | Investigating consumer perspectives on short message service reminders aimed at increasing participation in the National Bowel Cancer Screening Program

Nicole Perry¹, Mark Jenkins², Carlene Wilson², Jennifer McIntosh^2,3, Nancy Baxter^4,5, Driss Ait Ouakrim², Belinda Goodwin^1,2,6

¹Cancer Council Queensland, Fortitude Valley, QLD, Australia

²Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

³Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia

⁴Department of Surgery, University of Toronto Faculty of Medicine, Toronto, ON, Canada

⁵Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

⁶Centre for Health Research, University of Southern Queensland, Springfeild, QLD, Australia

Aims: Despite playing a key role in the early detection of bowel cancer and improving outcomes for those diagnosed, participation in the National Bowel Cancer Screening Program has been consistently suboptimal, never exceeding 44%. Effective, evidence-based interventions are urgently needed to encourage more Australians to participate in bowel cancer screening. This study aimed to assess consumer perspectives on the usefulness, feasibility, and readability of various short message service (SMS) reminders aimed at increasing participation in bowel cancer screening.

Methods: Australians aged 50–74 (N = 1016) were invited to take part in an online survey. Participants were shown five SMS reminders displayed in a random order and asked to provide ratings after each SMS, followed by questions regarding their health communication preferences and sociodemographic information. Bayesian multilevel modelling was employed to examine the effects of SMS content type on clarity, usefulness, likelihood of encouraging kit return and likelihood of being irritated by each SMS reminder.

Results: SMS reminders that encouraged consumers to place their kit somewhere visible (b = 0.45, CrI[0.33, 0.56]), included a GP endorsement message (b = 0.32, CrI[0.21, 0.43]), or included brief instructions on how to complete the kit (b = 0.22, CrI[0.11, 0.33]) were rated as more likely to encourage kit return than a plain reminder SMS. The visible, GP and instruct SMS reminders were also rated more useful than the plain SMS reminder (visible: b = 0.38, CrI[0.27, 0.49]; GP: b = 0.16, CrI[0.04, 0.27]; instruct: b = 0.27, CrI[0.16, 0.39].

Conclusions: Findings from the present study suggest that SMS reminders may be optimised for efficacy by modifying the contents included in the reminder. GP endorsement, provision of brief instructions or suggesting placing the kit somewhere visible are some potentially effective inclusions in such a reminder.

463 | National pancreatic cancer roadmap: Developing pathways to pain management and early palliative care for people with pancreatic cancer

Jennifer Philip^1,2,3, Melanie Lovell⁴, Isabel E Young⁴, Kylee Bellingham³, Georgia Christopoulos³, Mei Krishnasamy⁵, Gregory Crawford^6,7, Nicole Rankin⁸, Gail Garvey⁹, Kara Burns¹⁰, Farwa Rizvi²

¹Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, VIC, Australia

²St Vincent's Hospital, Fitzroy, VIC, Australia

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

⁴Palliative Care, HammondCare, Greenwich, NSW, Australia

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

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

⁷Palliative Medicine, Lyell McEwin Hospital, Modbury, SA, Australia

⁸School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia

⁹Indigenous Health Research, Univeristy of Queensland, Brisbane, QLD, Australia

¹⁰Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, Australia

Aims: The National Pancreatic Cancer Roadmap, developed by Cancer Australia, details a set of priorities towards improving care and outcomes for people affected by pancreatic cancer. This project aimed to develop pathways to timely pain management and early palliative care along with clinical guidance, education for health professionals, information for patients, digital solutions and implementation recommendations to support the Roadmap.

Method: Themed Working Groups (n = 4) comprised of clinicians (across disciplines) and community members met on four occasions to consider evidence from literature reviews, enriched by lived experience to develop suggestions for project outputs. These suggestions were in turn considered by stakeholder groups (n = 4). The stakeholder groups included clinicians, patients, caregivers, culturally and linguistically diverse people, Aboriginal and Torres Strait Islander people, and peak pancreatic cancer groups across all states and regions, with feedback in turn provided to the Working Groups. In this iterative manner project outputs were produced.

Digital solutions and Implementation recommendations were similarly produced by targeted literature reviews, supplemented with experience and ‘road-testing’ potential solutions with participants as well as digital IT providers.

Results: In total, 84 participants contributed to produce the pathways to pain management and early palliative care and supporting materials. This involved: 10 literature reviews, 11 evidence summaries, five environment scans, 37 meetings, and 15 digital IT interviews. Data from these activities informed production of pathways to timely pain management, to early palliative care, a pain assessment tool, clinical guidance to support the pathways including for Aboriginal and Torres Strait Islander Peoples, health professional education module and patient information about interventional pain management, implementation strategies for the pathways and guiding principles to inform equitable digital solution development.

Conclusion: Extensive consultation and longitudinal iterative processes enabled the development of nationally applicable pathways to improve care for people with pancreatic cancer.

464 | A methodology to effectively develop national care pathways for people with pancreatic cancer, as part of the National Pancreatic Cancer Roadmap

Jennifer Philip^1,2, Nicole Rankin³, Isabel E Young⁴, Kylee Bellingham⁵, Georgia Christpoloulos⁵, Farwa Rizvi⁵, Mei Krishnasamy⁶, Gregory Crawford^7,8, Gail Garvey⁹, Kara Burns¹⁰, Melanie Lovell⁴

¹Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, VIC, Australia

²St Vincent's Hospital, Fitzroy, VIC, Australia

³School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia

⁴Palliative Care, HammondCare, Greenwich, NSW, Australia

⁵Medicine, University of Melbourne, Parkville, VIC, Australia

⁶School of Nursing, University of Melbourne, Parkville, VIC, Australia

⁷Medicine, University of Adelaide, Adelaide, South Australia, Australia

⁸Palliative Medicine, Lyell McEwin Hospital, Modbury, South Australia, Australia

⁹Indigenous Health Research, Univeristy of Queensland, Brisbane, QLD, Australia

¹⁰Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, Australia

Aims: The National Pancreatic Cancer Roadmap, developed by Cancer Australia, sets out the need to establish pathways to timely pain management, including interventional pain management and palliative care, with supporting Clinical Guidance at key stages of the pathways. We describe a methodology for pathway development that prioritised community and clinician engagement.

Methods: A longitudinal iterative co-production methodology informed by program logic and deliberative dialogue approaches was chosen to guide participant engagement, assess data from evidence reviews and participant experiences, and develop and achieve consensus on project outputs. Deliberative dialogue fosters dialogue across diverse groups when interpreting scientific and contextual knowledge to inform health policy. Themed working groups (n = 4), stakeholder groups (n = 4) and an expert advisory group (n = 1) were established including clinicians (pain, palliative care, oncology, general practitioners, radiologists and gastroenterologists), patients, carers, community organisations, culturally and linguistically diverse, and Aboriginal and Torres Strait Islander people (n = 84 participants). Each group met on four occasions to review evidence, provide feedback, and confirm collated outputs. The expert advisory group provided project oversight and final review of outputs.

Results: In total 37 meetings led to the working group and stakeholder co-production and endorsement of care pathways, clinical guidance, health care education modules and patient information for pancreatic cancer. The longitudinal iterative methodology enabled participants to recognise their suggestions being included as work progressed. Providing pre-reading, updated meeting summaries and specific focused questions led to increased productivity and group engagement. The range of participants’ backgrounds ensured outputs had broad applicability, including for priority populations. Grouping participants with similar experiences allowed greater depth of discussions.

Conclusion: Through an iterative deliberative dialogue consultation process, we successfully coproduced a set of community endorsed care pathways and resources for pancreatic cancer care with national application. This approach to engagement has relevance for other national policy and guideline production.

466 | Embracing innovation: Developing a forward-thinking workforce model for a growing regional clinical trials unit

Michelle Pryce¹, Jhodie Duncan¹, Anita Raymond¹

¹Latrobe Regional Health, Traralgon, VIC, Australia

Latrobe Regional Health (LRH) is a major regional health service in Gippsland, Victoria, with a strategic vision to enhance patient access to clinical trials closer to home. To support this vision, LRH established the Research and Clinical Trials Unit (RCTU). In January 2020, the RCTU comprised four part-time staff managing two clinical trials. Since then, the unit has expanded to over 20 staff and recently launched its 36^th clinical trial.

A key challenge in expanding our clinical trial portfolio was attracting and recruiting qualified staff to a regional area. To address this, our unit implemented an adaptive workforce model to enhance our capabilities and build strong support networks for ongoing growth. Furthermore, we recognise that establishing strong partnerships with metropolitan health services has enabled us to facilitate weekly Oncology and Haematology Research Fellows Clinics at LRH.

In addition to our core team of Clinical Trial Coordinators, which includes both nurses and non-nurses, the RCTU has embraced a decentralised workforce model. This strategy leverages the expertise of disease-specific nurses from across the organisation. The RCTU provides these nurses with training and support for their professional development in research, along with departmental funding for trial-specific positions. This model has propelled the advancement of clinical trials in areas such as Haematology, Stroke, Cardiology, CCU/ED, Dermatology, and Diabetes. The involvement of specialised nurses has been crucial in overcoming significant barriers and ensuring the successful initiation of these studies.

We believe that by adopting an organisational approach, applying creative problem-solving, integrating trials into standard practice, and incorporating research roles into existing specialty positions, we can develop a clinical trial program tailored to our local community. Additionally, we will continue to build collaborative partnerships to cultivate a strong research culture across LRH.

467 | A systematic review of the implementation of geriatric assessment in cancer care

Mmakgomo Raesima^1,2, Tshepo Rasekaba^1,3, Christopher Steer^1,4,5, Irene Blackberry^1,3

¹John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia

²Deaprtment of Public Health, Ministry of Health, Gaborone, South East District, Botswana

³Care Economy Research Institute, La Trobe University, Albury-Wodonga, Victoria, Australia

⁴Border Medical Oncology and Haematology, Albury-Wodonga, NSW, Australia

⁵School of Clinical Medicine, Rural Clinical Campus, University of New South Wales, Albury, NSW, Australia

Aim: Geriatric assessment (GA) in older adults with cancer is part of recommended best practice guidelines, yet implementation is variable. This systematic review aims to evaluate the evidence on implementing GA in cancer care, including outcomes, and to identify and analyse barriers and enablers of GA implementation using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Preference for i-PARIHS draws from its wide use as a structured approach to understanding and addressing the complex factors that influence successful implementation, i.e. the evidence, the context in which evidence is applied, the role of facilitation and innovation introduced. This abstract focuses on the qualitative narratives of GA implementation

Methods: We conducted a systematic search of eight databases including MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, Scopus and JBI targeting studies on implementation of GA in outpatient oncology settings from 2015 to July 2024. Studies were restricted to English language and older persons aged ≥65 years. We will extract narratives about implementation of GA and undertake deductive thematic analysis and meta-synthesis using the i-PARIHS domains; a structured approach to crystalise implementation success factors if any.

Results: The systematic review is currently underway and anticipated completion is mid-September 2024. The search strategy identified 245 studies. The next phases are as follows: (1), title and abstract screening for relevance, (2) full text article retrieval and eligibility criteria assessment, (3) full text article review and data extraction and (4) analysis and synthesis of the evidence.

Conclusion: While this review is underway, it is anticipated that findings will provide insights into the extent to which GA is implemented in cancer care, highlighting both the barriers and enablers to its adoption. Understanding what affects implementation outcomes can be valuable for creating and carrying out strategies that seek to alter key determinants.

References:

1. Mohile S.G., Velarde C, Hurria A, et al. Geriatric assessment-guided care processes for older adults: a Delphi consensus of geriatric oncology experts. J Natl Compr Cancer Netw 2015;13(9):1120-1130. https://doi.org/10.6004/jnccn.2015.0125

2. Dale W. Why is geriatric assessment so infrequently used in oncology practices? The ongoing issue of nonadherence to this standard of care for older adults with cancer. JCO Oncol Pract. 2022;18*(6):475-477. https://doi.org/10.1200/OP.22.00016

3. Gajra A, Jeune-Smith Y, Fortier S, et al. The use and knowledge of validated geriatric assessment instruments among US community oncologists. JCO Oncol Pract. 2022; 18*(6):e1081-e1090. https://doi.org/10.1200/OP.21.00633

4. Dale W, Williams GR, MacKenzie AR, et al. How is geriatric assessment used in clinical practice for older adults with cancer? A survey of cancer providers by the American Society of Clinical Oncology. *JCO Oncol Pract. 2021; 17*(6):336-344. https://doi.org/10.1200/OP.20.00636

5. Dale W, Klepin HD, Williams GR, et al. Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol. 2023; 41*(26):4293-4312. https://doi.org/10.1200/JCO.23.00648

6. McKenzie G.A, Bullock AF, Greenley SL, Lind M.J, Johnson MJ, & Pearson M. Implementation of geriatric assessment in oncology settings: a systematic realist review. J Geriatr Oncol. 2021;12*(1):22-33. https://doi.org/10.1016/j.jgo.2020.08.010

7. Gladman JR, Conroy SP, Ranhoff AH, & Gordon AL. New horizons in the implementation and research of comprehensive geriatric assessment: knowing, doing and the ‘know-do’ gap. Age Age. 2016;45*(2):194-200. https://doi.org/10.1093/ageing/afv197

8. Conroy SP, Bardsley M, Smith P, et al. Comprehensive geriatric assessment for frail older people in acute hospitals: The HoW-CGA mixed-methods study. Health Serv Deliv Res. 2019;7*(25). https://doi.org/10.3310/hsdr07250

9. Nilsen, P. Making sense of implementation theories, models, and frameworks. Implement Sci. 2020;3.0:53-79. https://doi.org/10.1007/978-3-030-52910-4_4

10. Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Services Res. 2019;19:1-21. https://doi.org/10.1186/s12913-019-4420-7

11. Harvey G, Kitson A, Harvey G. Implementing Evidence-Based Practice in Healthcare. 2015; Taylor & Francis.

468 | Antimicrobial usage reporting: Bridging the gap between inpatient and day oncology centres

Michelle Rantucci¹, Bettina Kirk¹

¹Icon Group, South Brisbane, QLD, Australia

Aims: Antimicrobial usage surveillance is a mandatory component of the National Safety and Quality Health Service (NSQHS) Standards required for hospital accreditation. The National Antimicrobial Utilisation Surveillance Program (NAUSP) enables both monitoring of usage trends and benchmarking to other peer groups for inpatient hospitals, however a similar system is not available for day hospitals or oncology centres. The aim of this study was to establish an automated system for antimicrobial usage reporting for a private day oncology hospital group, ensuring relevance to the patient cohort and treatment intent.

Methods: The pharmacy team worked with a data analyst to identify the required data, including monthly antimicrobial utilisation reports, patient separation figures, and the appropriate antimicrobial drug and class inclusions. Each antimicrobial's defined daily dose was mapped to enable collation of various formulations of the same drug, and appropriate comparisons between facilities. The PowerBI platform was used to develop visualisation reports, and the data was verified.

Results: Automatic monthly PowerBI reports now generate once patient separation data and monthly drug usage figures are available. Visualisations enable day oncology sites to trend their own antimicrobial usage data over time, including total antimicrobial consumption with sub-analysis available for drug class, specific antimicrobials and particular formulations. These reports can also directly benchmark to other comparable facilities, enabling identification of excessive or unusual usage, or antimicrobials warranting further investigation or improvement.

Conclusions: An automatic visualisation report, requiring no manual data entry or manipulation from facilities, has enabled each day oncology hospital across the group to appropriately monitor antimicrobial usage trends relevant to this specialised area of practice, enabling the identification of any areas of concern, and thereby fulfilling accreditation requirements of the NSQHS Standards.

469 | Telepharmacy for outpatients with cancer: An evaluation of medication history taking by videoconsults using the consolidated framework for implementation research 2.0

Marissa Ryan^1,2,3, Elizabeth Ward^4,5, Clare Burns^5,6, Christine Carrington^1,7, Katharine Cuff⁸, Mhairi Mackinnon⁸, Centaine Snoswell^2,3

¹Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia

²Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia

³Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia

⁴Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia

⁵School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia