Australian behavioural research in cancer

Centre for Health Research and Psycho-oncology (CheRP), New South Wales

Tackling tobacco in socially disadvantaged populations
Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as Aboriginal and Torres Strait Islander people, the homeless, and people with mental illness or drug and alcohol problems, than in the general population. Community social service agencies provide an ideal setting for delivering smoking cessation care; accessing a high proportion of the groups with high smoking rates, they are a trusted source of support and open to providing cessation support. Cancer Council NSW has been working with NSW based community services at establishing partnerships for tackling tobacco among their clients.

As part of the Tackling Tobacco Initiative, CHeRP will conduct two linked action research projects. In the first study, CHeRP is conducting a series of focus groups with staff and clients of six community social service organisations, including Salvation Army, Benevolent Society, Uniting Care, Anglicare, Ted Noffs Foundation and Samaritans, regarding barriers and facilitators to providing smoking cessation care in this setting. The results of this phase will help inform the development of an appropriate intervention. The second study will be a pilot project in two community services to test the acceptability and feasibility of a smoking cessation intervention and examine the validity of smoking self-reporting among clients.

It is intended that this research will inform the development of suitable strategies for addressing the high smoking rates prevalent among socially disadvantaged clients of community social service agencies.

Qualitative exploration of dietary supplement use by recent cancer survivors
Food supplements and vitamins are widely used by cancer survivors as an adjunct to conventional treatment. A systematic review of the efficacy of nutritional interventions in cancer patients concluded that their impact was unknowable because of the limited number and poor quality of trials. Currently, no evidence indicates that dietary modification by cancer patients improves survival and benefits disease prognosis. Nutritional interventions may not be benign; beta-carotene supplementation yields unexpected adverse effects on lung cancer recurrence in smokers.

Lacking evidence of effectiveness (and showing evidence of harm), cancer patients nevertheless use dietary supplements. Diet is a clear area where they may feel they have some control.  Better understanding their patterns of consumption and reasons for using supplements would improve communication about the use of supplements during cancer treatment.

CheRP conducted qualitative research investigating the use of dietary supplements among survivors. Twenty survivors who had indicated they used dietary supplements were recruited from the longitudinal Cancer Survival Study. Participants took part in 20 minute semi-structured telephone interviews. Verbatim interview transcripts were analysed thematically. Theoretical saturation of relevant themes was reached after 18 interviews.

Preliminary analyses identified three strong themes in the areas of supplement and vitamin use: 1) assessing efficacy and confirmation of legitimacy; 2) the health professional-patient dynamic; and 3) access/use being mediated by socioeconomic status. In addition, the discussions helped to identify how and what patients want in terms of resources and access to advice from health professionals.

Behavioural Research and Evaluation Unit (BREU), South Australia

Program evaluations
Behavioural Research and Evaluation (BREU) conducts ongoing evaluations to inform the future directions of programs and services offered by Cancer Council SA. The extended hours of the Cancer Council Helpline, a workshop offered to general practitioners on prostate testing and accommodation facilities offered to rural people who require treatment or care in Adelaide in relation to cancer diagnosis, have recently been evaluated.

National sun protection in early childhood services
BREU recently completed a national survey evaluating the sun protection policies and practices of 1017 early childhood services. Reports were prepared for individual states and territories, and together with the national report they will provide Cancer Councils across Australia with a baseline for future monitoring. The national report found that while most early childhood services across Australia have written policies that include multiple sun protection strategies (in line with Cancer Council recommendations), sun protection could still be improved. The report also found that Cancer Council’s SunSmart Early Childhood Program has had a positive impact on services’ sun protection and provides an important reason for services to become SunSmart. The national report recommends that the program should continue to be promoted, with particular emphasis on the benefits of joining the program and what is involved in becoming a SunSmart service.

Community support for legislation restricting tobacco advertising at point of sale
In 2008, a telephone survey was conducted of 1876 adults aged 18+, from randomly selected households in South Australia, investigating community awareness of tobacco point of sale laws introduced in the previous year. Respondents were asked whether they approved, disapproved, or were indifferent to the new laws restricting the size and placement of cigarette pack displays, which includes the requirement for larger shops such as supermarkets to remove tobacco products from sight if their tobacco kiosks are visible from outdoors or from a mall. The findings revealed that awareness of the legislation among the community, particularly among smokers was high. Support for the legislation was high among the community overall and particularly non-smokers. Many respondents (unprompted) believed that tobacco product displays or advertising should not be allowed (31.3%) and 21.9% believed that displays encourage young people to start or continue smoking. The vast majority of current smokers reported that the tobacco product display legislation would have no impact on their cigarette consumption, while 11.3% reported that they may be more likely to smoke less cigarettes.

BREU has also secured a contract for three years with SA Government to continue providing Tobacco Control Research and Evaluation services. This funding allows Cancer Council SA to monitor progress and inform strategic directions for tobacco control in South Australia.

Centre for Behavioural Research in Cancer (CBRC) Victoria

Mass media campaign improves cervical screening across all socio-economic groups
Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia in 2005, was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorised into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests, and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period, and was equally effective in encouraging screening across all SES groups, including low SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low SES women may help lessen the underlying differences in screening rates across SES. Health Education Research (In press).

Web-based intervention to reduce distress and improve quality of life among younger women with breast cancer: randomised control trial
Younger women with breast cancer experience greater psychological distress and greater physical symptoms than older women with this disease. A new research grant has been awarded to CBRC and partners from beyondblue: the national depression initiative, Cancer Australia and National Breast Cancer Foundation. A randomised control trial will test the effectiveness of a web-based intervention addressing unmet information and supportive care needs in improving quality of life of younger breast cancer survivors. The web-based intervention will use expert system technology. We aim to recruit 342 women under 50 diagnosed with early stage breast cancer. Women will be randomised to the intervention or control condition. Women in the intervention condition will be directed to the website and will work through a four-step process comprising: (1) an assessment of unmet needs; (2) nomination of needs they would like to address; (3) nomination of preferences for receiving advice on how to access professional help, information about the issue, and information about self management strategies; and (4) provision of tailored strategies addressing the need. Women will be encouraged to use the program as often as needed over the nine month study period and will receive formal invitation to do so at two, four and six months. All participants will complete baseline and follow-up surveys at three and nine months post-study entry. If effective, the model is transferable to other cancer types and could be readily implemented to make delivery of information to address unmet needs of cancer survivors highly plausible.

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

Recent figures indicate one in eight Queensland men will develop prostate cancer in their lifetime, yet information on how men are diagnosed and treated for prostate cancer or how their diagnosis and treatment impacts on their lives and those of their families remains limited. As a result, Cancer Council Queensland has a dedicated prostate cancer research program that aims to improve health outcomes for men and their families and reduce the impact of prostate cancer in Queensland.

ProsCan study
ProsCan began in 2005 in collaboration with the Northern Section of the Urological Society and Queensland University of Technology. The study aims to document patterns of care for prostate cancer and better understand the resulting impact on health and quality of life. A telephone-based, nurse-delivered support program is also being trialled to assist men with localised disease in making treatment decisions and help them adjust to treatment outcomes. Over 1000 men are taking part in ProsCan and will be followed from diagnosis through to five years post-treatment.

First Degree Relatives Study
The First Degree Relatives Study is examining the health behaviours of men with a family history of prostate cancer to understand how men make decisions about their preventive health behaviours. The study commenced in April 2008, with over 300 men with a family history of prostate cancer aged between 40-70 years currently participating. Information from this study will inform the development of supportive care programs and educational resources aimed at addressing the specific needs of men with a family history of prostate cancer.

Sun Exposure, Vitamin D and Outcome of Prostate Cancer Study
This study is being conducted in collaboration with Cancer Council NSW and the University of Sydney to investigate the relationship between sun exposure, vitamin D and the recurrence or progression of prostate cancer. Men in ProsCan are invited to participate in this project, with over 300 men taking part since May 2008. 

ProsCan Partners Study
At present we have limited information on the long-term quality of life experiences of partners of men with prostate cancer. The Partners Study will address this issue by examining the experiences of the partners of men in the ProsCan project. Results will help us to understand how we can better support partners through the prostate cancer experience and allow Cancer Council Queensland to develop new support programs and services targeted to the needs of this group. Recruitment for the Partners Study began in February 2009. 

ProsCan for Couples
A significant proportion of men experience erectile problems after prostate cancer treatment. The ProsCan for Couples study will investigate the effectiveness of a new support program to help couples adjust to changes in sexual functioning resulting from radical prostatectomy. This telephone based intervention is designed to be delivered by trained nurses or peer support volunteers (men who have themselves undergone radical prostatectomy). Study recruitment commenced in March 2009.

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