Australian behavioural research in cancer


New Results

Centre for Cancer Control Research and Tobacco Control Research Evaluation (TCRE) SA

Monograph series (CCCR)
The Centre published its 8th monograph on South Australian cancer statistics, entitled Time trends in cancer mortality in South Australia between 1990 and 2011. The monograph showed that cancer now accounts for about 28% of deaths in South Australia. It was reassuring that age-adjusted death rates between 1990 and 2003 showed a 10-year reduction of 12% in males and 8% in females.

Cancers contributing to reductions in males included those with a primary site of lung (24% reduction), prostate (18% reduction), large bowel (17% reduction) and stomach (26% reduction), whereas cancers contributing to reductions in females included those with a primary site of breast (19% reduction), large bowel (13% reduction), stomach (33% reduction) and cervix (40% reduction).

Factors responsible for these reductions are considered to include:

  • Male lung cancer – reduced tobacco smoking
  • Female breast cancer – earlier detection through screening mammography and gains in adjuvant therapy
  • Prostate cancer and large bowel cancer – potential treatment gains and earlier detection
  • Stomach cancer – improved refrigeration, potentially reduced infection with Helicobacter pylori, and in some instances, increased consumption of fruit and vegetables and a reduced salt intake.
  • Cervix cancer – increased screening coverage of older women and other high-risk groups.

Despite reductions in age-adjusted mortality rates for all cancers combined, absolute numbers of cancer deaths are projected to increase by about 9% in the 10 years to 2011, due to increases in population size and ageing. This will impose upward pressure on end-of-life cancer services.

The health behavioural implications of these mortality trends have been reviewed and opportunities for interventional studies considered.

Patient and carer perceptions of cancer care study
Telephone surveys were conducted with approximately 470 cancer patients being treated at 2 major public hospitals in South Australia and 350 carers of their carers to measure their perception of the care provided to them during admission and at discharge from hospital. Findings suggest that patients and carers perceive the clinical care provided to be very good. Issues that need addressing in terms of improving experiences for both patients and their carers include the provision of more written information, enhanced psychosocial support and better planning and communication around discharge. In general, carers reported less favourable experiences than patients. Results were similar at both hospitals.

Referrer feedback on the value of the respite care program of The Cancer Council South Australia
A brief questionnaire was sent to all health professionals who referred clients to The Cancer Council South Australia’s (TCCSA) Respite Care program during the first 6 months of 2005. The purpose of the questionnaire was to determine whether the program was meeting the needs of their clients and was still necessary given the availability of commonwealth grants for carer respite. Results indicate that TCCSA’s Respite Care Program is an important source of funding and is perceived by some to provide more flexibility than the Commonwealth Carers Respite Funding. Often both sources of respite funding are used to create an extended care package that allows patients to die at home, which may not have been possible otherwise.

Evaluation of the local government sun protection program
The local government sun protection survey has been conducted in1999, 2002 and 2005. These surveys have examined activities undertaken by local governments to enhance sun protection for community members, as well as council employees. Results show some improvements, particularly in relation to councils recognising their role in protecting community members from excess sun exposure. Legislative requirements have resulted in substantial improvements in relation to protecting council workers, however progress in the area of shade creation has been much slower. Limited funding is a major barrier for some councils. Further gains are most likely through taking an advocacy approach at the Local Government Association and State Government levels, with the aim of strengthening legislative requirements for councils to protect it’s community members.

Evaluation of the 2005 Quit television campaign – “Bubblewrap”
In May 2005, Quit SA aired a new television campaign “Bubblewrap”. The commercial featured a pair of lungs made from bubble wrap, with the bubbles being burnt by a cigarette. Responses of smokers to the campaign were very favourable. Comments reflected that the execution of the commercial was effective in communicating its message, and the content of the message itself was seen as important and motivating to prompt quitting.

Cinema Project
The Cancer Council NSW developed an anti-smoking advertisement for the cinema. The intention was to place the advertisement before movies which are seen by young people and which include considerable smoking. It was hoped that the anti-smoking advertisement would help to “inoculate” young people against the pro-smoking depictions of tobacco use in the movies, by raising their awareness and critical analysis of smoking in movies. A controlled trial was established and South Australia administered an arm of the trial. The Cancer Council NSW has the findings.

Keep Left Youth Smoking Cessations Workshop
The Keep Left Youth Smoking Cessation Guide was developed by Curtin University of Technology in Western Australia for the Smoking Cessation for Youth Project. The guide was developed as a resource for school nurses to: encourage students who smoke experimentally or occasionally to quit; reduce or prevent progression to smoking more; and encourage students who smoke regularly to quit or reduce the number of cigarettes they smoke.

Quit SA adopted the guide for use in schools and ran four workshops. Attendees were asked to complete evaluation forms at the end of the workshop. Overall the feedback was positive, the workshops were considered to be a good introduction to the cessation guide, which was widely accepted as a great mechanism for teaching students and staff how to quit smoking. They were also useful in educating staff on ways to implement this guide into their own drug strategy program.

Review of the Australian Quitline Services: in preparation for new cigarette packet health warnings
In March 2006, graphic cigarette packet warnings will be introduced in Australia. In addition to the new graphic images, the Quitline number is being displayed prominently on cigarette packets for the first time. This review was undertaken to identify the likely impact of these initiatives on the Australian Quitline Service, to review the Quitline service in its current form and to make recommendations about mechanisms that would enable the Quitline to deliver a responsive, consistent, research base and effective service to smokers in Australia. It was found that Quitline, though administered differently in each state and territory, is more consistent than it is different. The review of the Quitline found that the callers to the Quitline from anywhere in Australia would receive a good level of service, however there was room to enhance consistency and service. Recommendations were that a defined set of Minimum National Standards be implemented.

Critics’ Choice
The Critics’ Choice program is an anti-tobacco resource utilised in schools across South Australia. Students were asked to critique 12 commercials and to vote for which commercial they thought would most likely prevent them from smoking. Teachers were also asked to evaluate the program. Results from the teachers survey indicate that the resource is easy to use and integrate into school lessons and complements the existing drug and tobacco component of the curriculum. It was found that the Critics’ Choice resource raised awareness, as well as influenced perceptions about smoking. Despite findings being specific to the commercials included in the 2004 resource, the findings suggest that the Critics’ Choice resource is a valuable educatory tool.

Centre for Behavioural Research in Cancer Control (CBRCC) WA

New UV Index Format
In October 2005 Dr Owen Carter was commissioned by the National Skin Cancer Committee (NSCC) of The Cancer Council Australia and the Bureau of Meteorology to test various UV Index display concepts designed for inclusion on the daily weather forecast pages of newspapers throughout Australia. Four concepts were tested with a convenience sample of 300 Perth residents in October 2005. Results strongly favoured the Bell Curve concept over the traditional method of reporting the UV index and two other alternatives. The Bell Curve concept performed particularly well as it highlights the variability of UV conditions throughout the day and the importance of solar noon. This format has now been adopted by 48 newspapers around Australia.

Cancer in the workplace
The Cancer Council WA commissioned CBRCC to conduct a series of interviews and focus groups with people with cancer and their employers, to discuss their experiences of continuing to work while undergoing treatment. The results suggest that a majority of people with cancer chose to continue working throughout their cancer experience, with varying levels of flexibility and support from their employers. What was highlighted by the consultations is the important role the workplace has in facilitating the cancer journey of sufferers by providing a mentally cathartic semblance of continuity while their cancer treatment progresses and ongoing exposure to the social support networks provided by co-workers. Guidelines were developed from the results to facilitate workplace challenges that arise when an employee is diagnosed with cancer.

1997-2005 National Quit Report Audit
Under the auspices of the National Quit Coordinators group, CBRCC has received over 350 mainly unpublished research reports from the Quit offices of all states of Australia from 1997-2005. Dr Owen Carter presented a talk entitled “Looking Back, Moving Forward: We’re Not Done With Smoking Yet” which outlined preliminary results from television campaign evaluations. These suggest that: hard-hitting, visceral ads are highly effective; clear figure ground executions are most memorable; attention is best gained by presenting new information; high media weights predict high advertising cut-through and recognition rates (mediated by message and execution); sadness and fear are better motivators to quit than humour and entertainment; and advertisements aimed at adults are equally effective on teenagers.

Centre for Behavioural Research in Cancer (CBRC) Vic

National study of sun protection behaviours and related attitudes
In 2003, with funding from state Cancer Councils, the Australian Government Department of Health and Ageing and the National Cancer Control Initiative, a research group coordinated by CBRC was convened to carry out the first national survey to monitor Australians’ sun protection behaviour to assist the development of skin cancer prevention strategies.

A total of 5073 interviews of adults, 699 interviews of adolescents and 1140 parent proxy reports of children aged up to 11 years were conducted on Monday evenings over eight weeks of summer. Reports released in 2004 and 2005 on adults and adolescents have previously been circulated to Cancer Councils.

In the third report on children released in late 2005, compared with adults and adolescents, children were overall better protected from the sun during their outdoor activities. Parent’s reports indicated 73% of children were outdoors during peak UV times on summer weekends and spent on average 110 minutes outdoors. When outdoors, 42% of children wore a protective style of hat, 58% wore sunscreen (SPF15+), while shade, sunglasses and clothing were less commonly utilised. However, 8% of children were sunburnt when they were outdoors on summer weekends suggesting room for further improvement. A significant association with parent role modelling of sun protective behaviours was also found. These and other detailed findings of the study will assist Cancer Councils in refining specific strategies to encourage children’s skin cancer prevention.

Exposure to and perceptions of the dangers and illnesses of passive smoking among Victorians: 2004
Data from the 2004 Victorian Population Survey indicates that many Victorian adults are exposed to passive smoking. Almost half (48%) reported being somewhere in the past 48 hours where people have been smoking cigarettes. Most respondents (80%) said they had some level of concern about being exposed to passive smoking. Seventy-three per cent indicated they believed lung cancer can be caused by passive smoking, followed by asthma (70%), emphysema (65%) bronchitis (61%) and heart disease (60%). There was a relatively low level of belief among respondents that sudden infant death (30%), miscarriage (30%) and cancer of the cervix (16%), can be caused by passive smoking. Although most non-smokers suggested they do not like people smoking near them, only 6% of non-smokers said they would ask a person to stop smoking if they lit up a cigarette nearby, with the majority reporting they would simply move away (71%) or do nothing (18%).

Overall, this report suggests that many Victorian adults are concerned about being exposed to second-hand smoke and believe that passive smoking can cause a range of serious illnesses. Furthermore, findings suggest that using a ‘common courtesy’ approach (asking people not to smoke) is not effective on its own to eliminate exposure to second-hand smoke, and that legislative reforms are likely to be the only effective strategy to eliminate exposure.

The full research paper can be viewed at http://www.cancervic.org.au/cbrc-papers/rps17-2005.pdf

Does the effect of anti-smoking television advertising on calls to a Quitline vary by socioeconomic status?
It has been suggested that smoking interventions are less effective with low socioeconomic groups. In a recent paper, Mohammad Siahpush, along with Melanie Wakefield, Matt Spittal and Sarah Durkin from CBRC assessed socioeconomic variations in the impact of anti-tobacco television advertising on the number of calls to the Quitline in Victoria. These television advertisements predominantly featured hard-hitting messages on the health risks of smoking, plus promotion of the Quitline in Victoria. The outcome measure in the analysis was the number of calls to the Quitline for each week and each socioeconomic group for the period January 2001 to March 2004. Socioeconomic status (SES) was derived from the caller’s postcode using the Index of Socio-economic Disadvantage provided by the Australian Bureau of Statistics. The exposure measure was weekly Target Audience Rating Points (TARPs, a standard measure of television advertising weight) for anti-tobacco advertising broadcast in Victoria over the same period. The study found that call volume did not vary by SES in Victoria. That is, the increase in the number of Quitline calls as a response to a given increase in the volume of advertising was the same across socioeconomic groups. The findings indicate that anti-smoking media campaigns can prompt help seeking for quitting smoking equally among people of lower and higher SES.

Visit our website www.cancervic.org.au/cbrc for information about current CBRC research projects, details of our latest publications and access to the CBRC Research Paper Series.

Centre for Health Research & Psycho-oncology (CHeRP)

A monetary incentive increases postal survey response rates for pharmacists
Postal surveys are a well used tool for collecting data from a range of health related settings. Various incentives have been trialled to maximise response rates, with one of the most effective strategies being the use of a monetary incentive. Important community-based health care providers such as retail or community pharmacists have received little attention to date.

Dr Christine Paul and colleagues undertook research to explore the impact of a $20 incentive on response rates for pharmacists. A sample of 700 pharmacies in NSW was selected at random, with pharmacies eligible to participate if they had sold any Nicotine Replacement Therapy or bupropion in the previous month. The pharmacist in charge was sent a primer postcard followed by a brief survey regarding pharmacotherapies and advice for smoking cessation. One mail reminder and then one telephone reminder was provided to non-responders. Half of the sample was randomly allocated to receive an offer of $20 gift voucher.  The response rate for the voucher group was 65.9% and 53.5% for the no-voucher group.  The odds of response from the voucher group was 1.68 (95% CI=1.23, 2.30) times greater than for the non-voucher group.

The results indicate that a significant increase in pharmacists’ response rates to a postal survey can be achieved using a modest monetary incentive and that this incentive acts independently from using reminders that also increase response rates.

Viertel Centre for Research in Cancer Control (VCRCC), Qld

A new support program for men diagnosed with prostate cancer: The ProsCan program
Men diagnosed with prostate cancer experience a range of psychosocial and physical difficulties and in particular high levels of decision-related distress that can persist for long periods even after treatment has been completed. However, although the benefits of psychosocial interventions for patients with cancer are well accepted, research in this area specifically targeting men with prostate cancer is limited. In response, the Psycho-Oncology Research Unit within the VCRCC, in collaboration with the Northern Section of the Urological Society of Australasia, is undertaking a randomised controlled trial of a new support intervention, involving approximately 600 men diagnosed with localised disease.

The support intervention is a multi-component intervention applying therapy strategies proven to be effective in previous research and targeting these to specific challenges men experience in the early diagnostic and treatment phase of prostate cancer. On the basis that cancer threat appraisal has been found to predict decision-related distress the support intervention integrates psycho-education (ie, stress, coping and problem-solving models) and decision support in a novel approach. Structured counselling protocols and patient education materials underpin the telephone-based nurse delivered intervention that commences at diagnosis and extends six to eight weeks after treatment, with a booster session five months after treatment.

A pilot study of the support intervention was undertaken in late 2004 with 20 men newly diagnosed with localised prostate cancer (mean age 63.2 years; 85% married or living with a partner). Preliminary analyses from the pilot study found that men’s decisional uncertainty and overall decisional conflict were significantly lower after the intervention.

Recruitment for the main study began in April 2005. Recruitment is conducted within the private practices of urologists in Brisbane, Townsville and Mackay, and the urology departments of eight public hospitals in these regions. All men participating in the randomised controlled trial complete written questionnaires and short interviews at diagnosis and again at two, six, 12 and 24 months post-treatment. To date, out of 388 patients notified to ProsCan, 352 have been diagnosed with localised disease and of these 277 (78.7%) patients have agreed to participate in the trial of the support intervention.

This project forms part of a larger program of research which also aims to: examine the patterns of care and health-related outcomes for all men diagnosed with prostate cancer (localised or advanced) in Queensland; and in collaboration with the Queensland University of Technology, examine the genetic biomarkers associated with prostate cancer and their relationship to clinical outcomes.

Achieving broad reach translation for decision support in cancer
Cancer Helplines that provide broad access for the public to information and supportive cancer services are now widely available with established services in the UK, Europe, Australia, North America and elsewhere. While these services focus on the provision of high quality patient education, their potential role in supporting people facing cancer-related decisions has not yet been described. Decision support is a key need area in cancer care throughout the cancer trajectory, from cancer risk reduction and prevention, through early detection, diagnosis, treatment and to palliation or survivorship.

In a collaboration with the Ottawa Health Research Institute, focus groups were first held with Cancer Helpline staff in Queensland to identify cancer decisions frequently raised by helpline callers and barriers to addressing decision support needs of these callers. Following this, decision support skills training programs were held with 32 Helpline nurses and allied health professionals throughout Queensland with pre-post assessment of decision support knowledge and skills. The training program consisted of a web-based autotutorial, a three-hour seminar and was evaluated with pre and post simulated calls and knowledge, attitude and behaviour questionnaires.

After the training program, staff reported increased confidence in providing decision support and more positive attitudes towards decision support as a component of the Cancer Helpline service.

Decision support is set to increase in importance in line with the trend for patients to prefer greater involvement in decision making and increasing treatment choices and complexity of those choices.

Evaluation of the effectiveness of a targeted educational psychosocial workshop for Australian health professionals working in cancer care
This research aimed to evaluate the effectiveness of an educational workshop for oncology health professionals about the clinical practice guidelines for the psychosocial care of adults with cancer. In collaboration with the University of Queensland, a workshop was developed that integrated the guidelines with a stepped care approach to psychosocial care. The workshop included small group discussions and a lecture style format overviewing the psychosocial distress associated with cancer and risk factors for this distress; barriers to support; effective strategies for supporting patients and their families; and the tiered model of psychosocial care.

A total of 107 health professionals participated in this study from three regional locations in Queensland. The majority of participants were nurses from the community, domiciliary, aged care, practice nursing and hospital fields of expertise. Over 93% of participants were female, with a mean of nearly 23 years of clinical experience and a mean age of 48 years.  Approximately 53% of participants were not at all familiar with the NHMRC Clinical Practice Guidelines for the psychosocial care of adults with cancer and 40% were somewhat familiar before the workshop. Overall, participants rated the workshop between good and excellent.

After the workshop, participants rated their knowledge more highly in the areas of identification of psychosocial risk factors, psychosocial treatment, referral networks within their communities and understanding psychosocial effects of cancer. Participants’ confidence in referring cancer patients to appropriate external resource services and identifying distress were increased.

Extension of this work is planned for 2006.

Clinicians’ attitudes towards prostate cancer support groups
Clinicians’ attitudes have been found to be related to patients’ perceptions of their experiences at prostate cancer support groups. In collaboration with the Australian Prostate Cancer Collaboration, The Cancer Council NSW and The Cancer Council Victoria, a project was undertaken to assess clinicians’ knowledge and attitudes towards these groups.  In all, 36 clinicians from across Australia participated in this study. Analysis of the interviews revealed that peer support was rated positively by most clinicians and most report a fair to good knowledge of groups. However, less than one quarter of clinicians regularly refer to support groups. Further analysis is underway.

Prostate Cancer GP Education Program
The Queensland Cancer Fund, in collaboration with the Australian Prostate Cancer Collaboration, Queensland Faculty of the Royal Australian College of General Practitioners, the Northern Section of the Urological Society of Australasia, the National Cancer Control Initiative and other relevant groups recently developed a new education program and resource to assist GPs in supporting men to make informed choices about protein specific antigen (PSA) testing. The development process took place over a 12 month period with input from a range of health practitioners and experts including urologists, GP’s, psychologists, epidemiologists, educationalists, medico-legal experts and consumer groups.

The program was piloted with GPs in two regional and one major metropolitan setting and found the program was effective in increasing GPs’ knowledge about and confidence in discussing PSA testing with men. The workshop format and the practice resources were very positively evaluated. The program was subsequently further piloted in Victoria by The Cancer Council Victoria and is extending nationally. We are now developing the workshop materials into an online learning program for GPs with funding from Andrology Australia and in collaboration with gplearning, the online educational arm of the RACGP, and the Australian Prostate Cancer Collaboration.

Oncology nurses work satisfaction, job stress and preferences for further education
We surveyed 388 nurses working in oncology to assess their levels of job stress and job satisfaction and their preferences for further education in cancer care. Overall, the nurses reported a low intention to leave cancer nursing with more experienced nurses more satisfied and less stressed. A trend was observed for nurses who were working part time to report more stress in managing their workload. Nurses desired more training in pain and symptom management, palliative care, psychosocial aspects of cancer care and communication skills, with a preference for community-based seminars rather than courses in tertiary settings.

Easily accessed and practice-focused educational upskilling and mentoring provides a potential mechanism for maintaining the oncology nursing workforce.

Optimism and psychosocial outcomes in men newly diagnosed with prostate cancer
In order to effectively meet the supportive care needs of men diagnosed with prostate cancer, research needs to identify both men who are at risk of poorer adjustment following diagnosis and treatment of prostate cancer and effective treatment targets. In collaboration with Griffith University we examined the predictors of the course of psychological adjustment over time for men diagnosed with localised prostate cancer in 111 newly diagnosed men. Multilevel modelling techniques were applied to the data across four time periods: pre-treatment, and two months, 12 months and 24 months post-treatment.

Optimistic men were more likely to make a positive threat appraisal in the early stages of prostate cancer diagnosis and two years after treatment, the positivity of this appraisal results in better outcomes. By contrast, men who are not optimistic were less likely to make a positive cognitive appraisal of their situation and experienced more negative psychological outcomes. Men who are already optimistic at first presentation in the early stages of cancer treatment may require less intensive intervention as they are likely to already be utilising positive cognitions and coping strategies that are associated with positive psychological outcomes. These results have implications for the development of supportive care programs for men diagnosed with localised prostate cancer.

Skin cancer campaign targeting Queensland men under 40 years
The Queensland Cancer Fund Queensland Cancer Risk Study (2005) found that men aged 20-39 years are at increased risk of sunburn. This is especially true among those men who live in metropolitan areas of Queensland. Accordingly, focus groups were held with men to develop a sun safety educational campaign, which has been developed for the 2005/2006 summer, targeting this group. The key deliverables for this proposal are a radio community service announcement, brochure and poster with the concept “Because Grown-Up Skin Needs Protection Too”. Further development of the campaign and evaluation will take place in 2006.

Research in the Pipeline 

TCRE

Changes in State Government tobacco regulations
Amendments to the Tobacco Products Regulation Act (1997) introduced a phased in approach to smoke-free laws that affected workplaces, hospitality venues and tobacco retailers in South Australia. (See http://www.tobaccolaws.sa.gov.au./ for more details.) TCRE has planned an extensive evaluation around the smoke-free laws. To date TCRE has evaluated the impact of the communication campaign around phase one of the laws and analysed call volume to a tobacco control Infoline promoted to the public and hospitality industry to answer queries related to the laws. TCRE has also coordinated baseline and follow-up surveys with community and bar owner/manager to: assess support for and the impact of phase one of the restrictions; support for total restrictions in hospitality venues in 2007; impact on enjoyment, patronage and smoking behaviour. The results will be published in mid 2006. 

CBRCC

Life beyond cancer
The Cancer Council WA identified that people with cancer are typically well supported in both the diagnosis and treatment stage of their cancer journey, but experience difficulty accessing sufficient practical and emotional support during the post-treatment stage. CBRCC is currently analysing the results of nine focus groups and interviews with cancer survivors discussing their post-treatment experiences with the aim of developing a contemporary reference resource. The resource will be utilised by cancer support volunteers to enable clients to have an improved quality of life beyond their cancer diagnosis and treatment. A report is anticipated by mid-March 2006.

Television advertising to increase fruit consumption
Professor Rob Donovan and Dr Owen Carter of CBRCC have recently been awarded $155,000 over two years by Healthway to investigate using television advertising to increase fruit consumption in Western Australian children. Ms Linda Portsmouth will be using the project to complete a PhD under supervision at CBRCC. The study will explore the public health implications of recent breakthrough research which has established that advertising can change what adult consumers remember about their experience of using a product, without the awareness of the consumer. This advertising effect will be investigated to discover if advertising before consumption can positively enhance children’s anticipation of fruit eating, so making them judge these experiences as more enjoyable than they really are.

CBRC

The effects of anti-smoking advertising, tobacco-related press coverage and tobacco control policies on smoking behaviour
This study will relate indices of exposure to tobacco control media and policies to change in monthly smoking prevalence. Monthly population survey data from 1979 to 2005, supplied under special arrangement to CBRC by Roy Morgan Research for the five largest Australian media markets, will be analysed to assess changes in smoking prevalence and consumption.  The project will add indices of exposure to televised anti-smoking advertising from state and national campaigns and pharmaceutical company advertising for nicotine replacement therapy, as well as exposure to newspaper coverage on tobacco issues and dates of tobacco policy change (tobacco tax, smoke-free laws etc.) The project will then investigate the role of these tobacco control efforts on changes in smoking over time among the population overall and within population subgroups.  The project coordinator for this study is Sarah Durkin.

DCIS management since publication of clinical practice recommendations: surgeons’ practices and women’s experiences.
Ductal Carcinoma in Situ of the breast (DCIS) now represents 15% of all new cases of breast cancer. Although a benign disease, its diagnosis increases a woman’s risk of developing invasive breast cancer and the goal of treatment is prevention of invasive disease. To assist clinicians in making treatment decisions, the National Breast Cancer Centre (NBCC) published a set of eight evidence-based, clinical practice recommendations for the management of DCIS in September 2003. To help women understand a diagnosis of DCIS and to increase their involvement in treatment decisions, NBCC released a consumer guide to DCIS and its treatment in 2004. This project aims to i) examine the impact of clinical practice recommendations for the management of DCIS of the breast on clinical practice by assessing change in practice between 2002/03 (pre recommendations) and 2006/07 (post recommendations release); ii) determine awareness of and attitudes towards the recommendations among surgeons treating DCIS; and iii) among women diagnosed with DCIS in 2006/07 examine their experience of the diagnosis and treatment, their understanding of the prognosis for DCIS and awareness of information resources. This project will be coordinated by Claire Davey and Myee Pruden. 

CHeRP

Tobacco investment practices of superannuation funds
Previous research in Australia has demonstrated that community attitudes towards the tobacco industry are highly negative. However, public attitudes towards investments by superannuation organisations in the tobacco industry have never been investigated in an Australian study. It has been argued that one approach to tobacco control involves the economic isolation of the tobacco industry, since any market development by the industry will inevitably result in increased deaths. Superannuation organisations are the biggest investors in Australia, yet little is known about the degree of their involvement in tobacco industry ownership.

The study is being conducted by Dr Raoul Walsh and colleagues in two stages. The first stage surveyed 1,158 NSW residents about their views on the issue of investment in tobacco by superannuation funds. The survey was carried out in November 2004 and revealed that a majority of superannuation fund members object to their fund investing in the tobacco industry. Initial results indicate that 77% of respondents disagreed or strongly disagreed that it is ethical for superannuation funds and life insurance companies to invest in tobacco industry.

The second stage is a survey of medium to large superannuation funds in relation to their tobacco industry investments. Currently in the final stages of data collection, more than 100 superannuation funds have responded to the survey about their specific investment practices in tobacco and factors which influence decisions about such investments.

VCRCC

Documenting the experiences of women in the Amazon Heart Changing Gears motorcycle ride
Adventure activities to raise awareness and funds for breast cancer are increasingly common among breast cancer survivors. One recent activity held in Australia was the Amazon Heart Changing Gears motorcycle ride (http://www.amazonheart.com/). We used a qualitative methodology to investigate women’s psychological and social experience of this event with particular reference to benefit finding, peer support, survivorship and breast cancer identity. All 22 of the young women in the ride chose to participate in the study which included pre and post ride in depth interviews and journaling during the ride. Longer term follow up is also planned. Analysis of preliminary data is underway.

Identification of the psychosocial care needs of people with cancer in regional Queensland (Townsville) using a tiered model of care
Research consistently highlights the disparity in psychosocial support care between urban, and regional and rural areas. In 2006 a three phase project in collaboration with The Townsville Hospital (TTH) and James Cook University will address this issue.

The first phase will assess existing pathways of care, psychosocial care and the unmet supportive care needs and adjustment outcomes of people with cancer treated at TTH. This will identify targets for improvement in the psychosocial care and management of cancer patients at TTH to guide phase two of the project that includes consultative workshops with key stakeholders to identify ways to improve care. Following this a regional model for psychosocial care will be developed and implemented.

The project is due to commence in January 2006, with the implementation of a regional model of psychosocial care to commence in late 2006 and early 2007.

A project to identify future directions for QCF smoking prevention programs for primary school children
Smoking is common among Queensland school students and the risk of initiating smoking dramatically increases with each passing year from 12 to 17 years of age. Ten per cent of students aged 12 -15 years smoke and this figure dramatically increases to 25 per cent for students aged 16-17 years. In addition to this, 49% of Queensland secondary school students have tried smoking and this percentage is higher than the national average.  Adolescents caught smoking at school report that they first tried smoking at a mean of 10 years of age. Prevention programs delivered in middle high school may therefore be too late for preventing smoking in a substantial proportion of students.

In collaboration with The University of Queensland a systematic review of national and international primary school prevention programs will be undertaken in 2006. This project will provide a strong basis for developing a smoking prevention program for Queensland primary schools.  Importantly, the project will contribute to the development of a program that represents best practice in the inoculation of children against smoking uptake.

Passive smoking in private places community attitudes project
It is now well established that passive smoking is a direct cause of death and disease, including several types of cancer. Children are particularly vulnerable to passive smoke and exposure can lead to a number of illnesses and diseases in both the unborn and born child.  Currently, 40% of Queensland children aged 0-14 live in a home with at least one smoking parent. This exposure to passive smoke results in 21 children under the age of five dying and 380 children under the age of five being hospitalised in Queensland each year.

Significant adverse health effects for both children and adults occur in private places and this area is now considered an emerging issue for tobacco control advocacy programs.

In collaboration with the University of Queensland a Passive Smoking in Private Places Community Attitudes Project will be undertaken in 2006. This project will obtain population based Queensland data on community attitudes and behaviours with regard to passive smoking in private places.  This data will inform educational programs, as well as advocacy goals and provide a baseline for ongoing monitoring to further develop these areas.

Pool Cool Pilot Project
Skin cancer is one of the most common cancers in Australia, and it is also one of the most preventable. Few skin cancer prevention programs in outdoor settings, particularly public outdoor swimming pools, have been evaluated in controlled trials.

Because children, families and aquatics staff in Queensland spend many daylight hours exposed to the sun while minimally clothed, sun protection education at swimming sites can significantly affect important preventive behaviours. This study will pilot test the Pool Cool program (Glanz et al, 2002) intervention that has been successful in the US in improving skin cancer prevention strategies at swimming pools. Pool Cool was designed to encourage sun safety at pools in Hawaii and Massachusetts and to increase environmental supports and policies for skin cancer prevention.

Over the 2005-2006 summer, QCF will be piloting a skin cancer awareness program in collaboration with four swimming pools in Townsville and Brisbane. The main objective of the program is to increase awareness, motivation, and sun protection practices among children aged 5-10 who take swimming lessons, their parents, pool staff (lifeguards, pool managers, and swim instructors) and other pool users, such as families or individuals at free or recreational swims. Specific interventions include: (1) a swim instructor training module; (2) a 10-lesson curriculum on sun safety that is presented by swim instructors as part of their classes; (3) sun protection messages, educational materials, and reminders for children and parents; and (4) provision of environmental supports including policy implementation, sunscreen provision, and signage.

The comparison group for this intervention will be an Active Healthy Living program to promote physical activity and healthy eating.

News

TCRE

Dr Linda Foreman resigned as Group Executive Research and Development as of 22 December 2005. Professor David Roder has commenced as the new Group Executive Research and Development.

Marianne Hoey and Dr Valerie Sedivy have joined the TCRE team as evaluation officers. Sarah Ellis-Steinborner joined the team as an Administration Officer. TCRE staff attended the Third Australian Tobacco Control Conference in Sydney last November. Three oral presentations and a poster were given.

CBRCC

New Director
Professor Rob Donovan stepped down as Director of CBRCC in 2005 but continues to work at the centre on a part-time basis on a number of projects. As of October 2005 he was replaced as Director by Professor Peter Howat, formerly the Head of the Department of Health Promotion at the School of Public Health at Curtin University.

3rd Australian Tobacco Control Conference
Two presentations were made by CBRCC staff at the 3rd Tobacco Control Conference held in Sydney on the 23rd to 25th  of November 2005. Professor Donovan gave a plenary talk entitled “Campaign messages likely to be on the horizon for tobacco control” and Dr Owen Carter presented a talk entitled “Looking Back, Moving Forward: We’re Not Done With Smoking Yet”.

CBRC

The Centre for Behavioural Research in Cancer (CBRC) has welcomed Francis Icasiano (BA (Hons)) who is serving as Data Manager on two projects examining media influences on smoking. CBRC was successful in winning a total of $711,000 in NHMRC project grants in the 2005 funding round. In addition, Professor Melanie Wakefield, Director of CBRC was awarded a five-year NHMRC Principal Research Fellowship.

CHeRP

CHeRP’s Year in Review 2004-2005 is now available. Copies are available by emailing CHeRP@newcastle.edu.au. An update of CHeRP’s current projects and staff can also be found at its website www.newcastle.edu.au/centre/cherp/index.html

CHeRP staff participated in the COSA Annual Scientific Meeting 2005. Professor Afaf Girgis delivered two presentations; one describing a program of work to develop specialist palliative care referral guidelines and assessment tools and the other reporting on the effectiveness of consultation skills training with oncologists in improving outcomes for people with cancer. Prior to the COSA Meeting, Afaf was also an expert facilitator during a two day Communication Workshop jointly held by ASCO and COSA.

Several CHeRP staff participated in the 3rd National Tobacco Control Conference 2005.  Dr Raoul Walsh gave a presentation about nursing and education students’ smoking behaviour and attitudes towards tobacco prevention and training; Dr Christine Paul gave a presentation on community perception of tobacco promotion in movies; and Flora Tzelepis gave a presentation on quit smoking behaviours and use of quitting assistance in NSW.

Ms Allison Boyes and Professor Afaf Girgis have been successful in attracting funds from the Hunter Medical Research Institute via the Honda Foundation for an Optical Mark Read Scanner. This infrastructure will enable the data entry for CHeRPs large-scale population health studies to be automated. 

VCRCC

The focus of the Psycho-Oncology Research Unit within the VCRCC is research into the psychological, social, and behavioural aspects of cancer control; and translation of this research into improved and effective clinical practice, public health interventions and optimal individual behaviour. This research program complements and interrelates to the work of our Epidemiology Unit.

In 2005, two reports were released from the VCRCC’s descriptive epidemiology program – Prostate Cancer in Queensland, 1982 to 2002 and Geographic Differentials in Cancer Incidence and Survival in Queensland, 1996 to 2002. In addition, two reports were jointly produced by the VCRCC and Queensland Health, Cancer Prevalence in Queensland 2002, and Cancer Survival in Queensland, 2002. The new information contained in these reports provides a more complete and up-to-date picture of cancer occurrence and differences in cancer survival across Queensland than has been available to this time. The results will assist the Queensland Cancer Fund and our stakeholders in planning research and cancer control activities and services in Queensland and will provide direction for research and program development. Copies of these reports are available on the Queensland Cancer Fund website.

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