Australian behavioural research in cancer

This is a regular feature in Cancer Forum describing behavioural applications in cancer prevention.

Australia has five behavioural research centres: the Cancer Prevention Research Centre (CPRC) of the University of Queensland, the Cancer Education Research Program (CERP) of The Cancer Council New South Wales, the Centre for Behavioural Research in Cancer (CBRC) of The Cancer Council Victoria, the Centre for Behavioural Research in Cancer Control (CBRCC) at Curtin University of Technology Perth, and the Centre for Cancer Control Research (CCCR) of The Cancer Council South Australia.

The Centre for Health Promotion and Cancer Prevention Research (CHPCPR) has changed its name to Cancer Prevention Research Centre (CPRC). 

This report has been edited by Cathy Swart (CPRC) from the reports received.

New results

Centre for Cancer Control Research (CCCR) and the Tobacco Control Research and Evaluation program (TCRE), SA

Cancer statistics monograph series
In June 2002, the CCCR distributed its third publication in this cancer statistics monograph series, entitled Cancers of the respiratory organs, throat and mouth. In August, the fourth publication was distributed, entitled Cancers of the female breast and gynaecological organs. About 1,240 South Australian women are diagnosed annually with cancers of these sites, about three-quarters of them breast cancers. Cancers of the breast and gynaecological sites account for about a quarter of all cancer deaths in South Australian women. A major emphasis is being given to screening to reduce numbers of deaths from breast and cervical cancers. Population screening with mammography was introduced in 1991, following a two-year pilot. It was directed primarily at 50-69 year olds, where the evidence of benefit was strongest. By 1997-2000, the female breast cancer death rate had reduced by about 19% in 50-69 year olds and 15% in older women. This is attributed to the combined effects of earlier detection from mammographic screening and advances in treatment, especially in adjuvant therapy. Compared with data for the 1980s, the percentage of invasive breast cancers found with diameters under 15mm has increased three-fold, although smaller increases are evident in women born in countries where English is not is not the main language. This has highlighted the need for promotion among these women to ensure that they are well represented in mammography and other early-detection programs. 

Over the past 20 years, death rates from cervical cancer have reduced by approximately two-thirds in South Australia, with most of this reduction being attributed to the Pap smear. The monograph specifies the high-risk groups, where further promotion of the Pap smear is required. It also underscores the increasing proportion of cervical cancers comprising adenocarcinomas and adenosquamous cell carcinomas. Their epidemiological features differ from those of the more common squamous cell lesions, with screening and broader management implications. South Australia has the lowest death rate in Australia from cervical cancer, but further headway will require more sophisticated screening promotion among those women still at high risk. This monograph, as for earlier releases, was directed at providing secondary school and tertiary students, including students in the health field, with information on cancer trends in South Australia, and opportunities for prevention and improvement in outcomes. The next monograph release will address the topic of surviving cancer, with an emphasis on psychosocial aspects.

The 12345+ Food and Nutrition Plan: Ten years and beyond
The Cancer Council South Australia and CSIRO Nutrition and Health Sciences developed The 12345+ Food and Nutrition Plan in 1991. The booklet – a simple guide to healthy eating and weight control – is the Cancer Council’s most requested resource, with over 150,000 copies ordered between January 1998 and September 2001. There are several other food guides currently produced in Australia, including The Healthy Eating Pyramid and more recently The Australian Guide to Healthy Eating. In light of these existing resources, we wanted to determine whether there was a need to continue producing The 12345+ Food and Nutrition Plan. 

A total of 20 in-depth interviews were conducted with dieticians and other health professionals who use or do not use the booklet. The need for a simple guide to healthy eating was clearly identified in this evaluation. Preliminary results showed that users were extremely positive about the simplicity of the resource and its relevance to significant client groups, especially those with low literacy levels. Non-users, however, felt the information was not in line with current recommendations and therefore not best practice. The Cancer Council South Australia will review the booklet in light of these findings.

Cancer Education Research Program (CERP), NSW 

Screening for colorectal bowel cancer: a community survey
Randomised controlled trials have shown that screening for colorectal cancer with faecal occult blood tests (FOBTs) produces a modest, but significant, reduction in mortality. However, there is little evidence to indicate the feasibility or acceptability of population screening for colorectal cancer in Australia, and there is currently no organised approach. As part of a computer-assisted telephone survey, Professor Jill Cockburn and colleagues examined the extent and modality of screening for colorectal cancer among NSW residents aged over 40 with varying degrees of familial risk. The results indicated that 5.7% of those at average risk aged 40-49, 18.4% at average risk aged 50+, and 7.9% at above average risk report having had at least one faecal occult blood test (FOBT) in the previous five years. Of those at average risk, 24% aged 40-49, and 32% aged 50+ indicated an intention of having FOBT in the next two years, compared with 25% of those at above-average risk. This study provides important baseline data with which to compare the progress of both pilot screening programs and more widespread implementation of colorectal cancer screening in Australia. Further results from this study have been published in the Australian and New Zealand Journal of Public Health (June 2002).

Cancer Prevention Research Centre (CPRC), QLD

Enhancing multidisciplinary care of women with breast cancer
It is well recognised that best practice in the management of breast cancer involves a multidisciplinary approach to care. This approach has been found to have a positive influence on the psychosocial well-being and survival of women with breast cancer. GPs would like to be more involved in the continuing care of their breast cancer patients, and play a key role in the multidisciplinary team. In the primary care setting, GPs are uniquely placed to provide to the breast cancer patient appropriate information, referral, treatment options, counselling and support, and follow-up. An 18-month project was initiated by Queensland Health in conjunction with the Brisbane North Division of General Practice and the Cancer Prevention Research Centre at the University of Queensland. 

The project aimed to explore ways to enhance the current role of the GP in the care of women with breast cancer. This entailed developing, implementing and evaluating a strategy designed to improve communication between tertiary and primary sector providers following referral of patients to a hospital breast clinic.  Qualitative and quantitative methods were used to survey GPs, medical consultants, breast care nurses and administrative staff at the breast clinics of two major public hospitals in Brisbane. An initial survey identified communication needs and perceptions. This informed the development of a communication protocol that was pilot-tested, then evaluated in a follow-up survey. The protocol involved a registered nurse from the breast care clinic, the streamlining of pathology reporting, and the use of a dedicated fax machine and customised forms in the breast clinic. The results of the evaluation suggest that the protocol has certainly improved communication. Review and refinement of the protocol is continuing during the introductory period.

Research in the pipeline


Australian secondary students alcohol and drug survey (ASSAD)
CBRC is coordinating the seventh survey of tobacco and alcohol use among Australian secondary school students that is currently taking place across Australia. David Hill and Victoria White are the principal investigators. Jane Hayman, the national coordinator of the study, obtains prevalence estimates of tobacco smoking and alcohol drinking among secondary school children throughout Australia at three-yearly intervals. Since 1996, questions about secondary students’ use of illicit substances and non-prescription pain killers have also been included. Approximately 30,000 12-17 year-old male and female secondary students across Australia are being asked to complete a questionnaire to collect self-report data on use of tobacco, alcohol and other licit and illicit substances. 

The ASSAD study is a valuable tool in tracking smoking prevalence amongst Australian secondary school students over time. In results recently published in the Australian and New Zealand Journal of Public Health, comparisons across survey years showed that while fewer 12-15 year-olds were current smokers in 1999 than in 1996, the proportion of current smokers in 1999 and 1996 among 16 and 17 year-olds was similar. It was concluded that the rise in the prevalence of smoking among younger secondary students seen in the 1990s seems to have stopped and smoking prevalence has declined.


Perceptions of treatment and service provision of patients with advanced cancer
A preliminary report has recently been submitted to the Palliative Care Program within the Commonwealth Department of Health and Ageing. The report reviewed the literature from 1980- 2001 on Information given to patients receiving treatment for their advanced cancer. It sought to place into context the substantial changes in cancer care within the last 20 years, examining research findings in regard to cancer beliefs, attitudes and knowledge. A final report on Patient perceptions of treatment and service provision will draw together the implications for clinical policy of findings from both patients and their care-givers in a longitudinal study and be submitted to the Commonwealth by the end of the year. We anticipate responding with health promotion material to the current public attitudes around death, dying and cancer pain.

Hospitality smoking bans are popular among all patrons
TCRE has investigated support for smoking bans in bar and gaming venues, among those who regularly frequent such venues. New findings indicate that, contrary to some claims by the hospitality industry, smokers are in a minority among regular bar and hotel patrons. Although the rate of reported smoking is the highest amongst regular front bar drinkers – and even among this group, smokers are a minority. Support for smoke-free venues among regular patrons is high, with most patrons (including regular front bar patrons) reporting that visiting these venues would become more enjoyable if smoking were banned altogether. TCRE is currently planning future surveys to investigate this issue further.


Training in communication skills from a distance: an oxymoron or reality?
Researchers from the Cancer Education Research Program, The Cancer Council NSW/University of Newcastle, the Medical Psychology Unit and Department of Cancer Medicine at the University of Sydney, along with clinical colleagues from a number of major Australian oncology clinics, have been awarded a National Health and Medical Research Council grant aimed at improving outcomes for people with cancer through the training of oncologists in communication skills.

The consultation skills training program will be based on the current best advice from the National Breast Cancer Centre and National Cancer Control Initiative document Clinical practice for the psychosocial care of adults with cancer (currently in draft form), and will focus on recognising emotional and psychological cues from patients and initiating appropriate management.

The program will consist of 10 hours contact over a period of six months, with the first two sessions being interactive face-to-face workshops. Clinicians will rehearse aspects of the consultations with actors as simulated patients, and self-appraise the way that they dealt with psychological issues. These sessions will be facilitated by an oncologist and a psychologist or psychiatrist with experience in consultation skills training. All of the remaining four sessions will be conducted by video-conference, with the facilitators working from a central location and the clinicians and actors participating from one of the four remote locations. 

Randomised controlled methods will be used to assess the effectiveness of the program in terms of improving patients’ quality of life, preventing patients’ psychological morbidity and reducing the risk of burnout amongst doctors.

The project will be managed by Michele Bandaranyake now that her PhD thesis has been submitted.


Genetic science, molecular biotechnology and the public’s perceptions of future prospects for the prevention and cure of cancer
Neville Owen and Andrew Wilson from CPRC and the School of Population Health, and Wayne Hall and Shirlene Badger from the Institute for Molecular Biosciences at the University of Queensland, together with Jeff Dunn and Joanne Aitken from the Queensland Cancer Fund will be carrying out an exploratory study on factors that may be shaping the public’s perceptions of future prospects for the prevention and cure of cancer. The context of the study is people’s beliefs about the likelihood of future cures for cancer or the prevention of cancer. 

Media coverage of the ‘promises’ of genetic and molecular technologies may influence people’s understanding of, and motivation to act on, preventive messages promoted by cancer organisations (and other bodies concerned with primary prevention of chronic disease). Additionally, mixed messages in relation to advances in bio-molecular treatment of disease and potential ‘cures’ for cancer may create decisional ambiguity and compromise adjustment for cancer patients and their families. Health messages about not smoking, maintaining a healthy body weight, following healthy dietary guidelines and being physically active may be undermined by the explicit or implicit promises of cure and prevention through applications of molecular and genetic technologies.

‘Technological optimists’ argue that higher levels of awareness of advances in genetic science and molecular biotechnology are associated with greater health awareness. If the optimists are right, then those who have high levels of knowledge will have higher levels of interest, motivation and intention to undertake personal preventive actions to reduce cancer risk. This could happen if more information encouraged people to identify their risks and take steps to change them, and to present early for treatment. ‘Technological pessimists’ argue that higher levels of awareness of advances in genetic science and molecular biotechnology are associated with ‘unrealistic optimism’ about future prospects for a cancer cure and ‘technological’ prevention. If this were true, they will have lower levels of interest, motivation, intention and/or personal preventive actions in relation to cancer risk. This project will assess levels of awareness among Queensland adults of the ‘promises’ of health benefits flowing from advances in genetic research and molecular biotechnology and how this may impact of prevention-related beliefs and behaviours.

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