Australian behavioural research in cancer

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

“Any concerns or worries that I may have as a carer are dismissed, most days I feel invisible”: A longitudinal analysis of cancer caregivers’ unmet supportive care needs

It is recognised that partners and caregivers of cancer patients confront a range of psychosocial challenges, yet psychosocial services to help partners and caregivers meet the demands of their new role are lagging in comparison to those available to patients. This analysis aimed to identify the level and type of unmet supportive care needs of partners and caregivers of cancer survivors, identified through a population-based sample of cancer survivors participating in CHeRP’s Cancer Survival Study. Participants completed a self-report survey at approximately six (n=547), 12 (n=521) and 24 (n=442) months post survivor diagnosis. Unmet needs were measured by the Supportive Care Needs Survey – Partners and Caregivers. Half of the partners and caregivers experienced at least one moderate/high unmet need at six months post-diagnosis, with almost one third still experiencing moderate/high unmet needs two years post-diagnosis. On average, participants reported 4.6, 2.9, and 2.1 moderate/high needs across these time points. Many of the top ranking needs remained the same across time, including ‘managing concerns about cancer coming back’ and ‘reducing stress in the person with cancer’s life’. However, at 12 and 24 months, some information and cancer care related needs became less prevalent and were replaced by needs focusing more on the health and wellbeing of the partners and caregivers themselves (eg. ‘looking after their own health’). Understanding the level and type of unmet needs is critical for evidence-based health care planning and resource allocation.

FamilyFIT: An innovative approach to increasing physical activity in children

It is well established that regular participation in physical activity (PA) provides children with physical, psychological, social and emotional benefits. The more PA undertaken, the greater the benefits. However, despite these benefits, a significant proportion of Australian children do not achieve recommended levels of PA for health (60+ minutes moderate to vigorous PA each day). Parents and the family environment play an important role in influencing children’s PA behaviours, but there is a lack of evidence regarding effective strategies that engage parents to promote child PA. To address this gap, families with primary school-aged children will be recruited into a pilot randomised control trial to evaluate the feasibility (acceptability and deliverability) and preliminary efficacy of a family focused community based intervention (FamilyFIT) designed to increase child and parent PA levels. Parents will be provided with information, skills and tailored resources to support parenting strategies which influence activity behaviour, and establish a home environment conducive to PA. Children and their parents will participate in fun, skill-based PA activities together. Recruitment of families will commence in 2011. PA will be measured via self-report and objectively using activity monitors. This project is funded by a Hunter Children’s Research Foundation/Hunter Medical Research Institute grant and a University of Newcastle/Centre for Health Research and Psycho-oncology PhD scholarship.

Behavioural Research and Evaluation Unit (BREU), South Australia

Evaluation of the impact of the SA Health Smoke-free Policy on SA Health staff
On 31 May 2010, a Smoke-free Health Services Policy was introduced in South Australia prohibiting smoking (by staff, consumers and visitors) on all SA Health sites, including buildings, structures, outdoor areas and in government vehicles. To determine the impact of this new smoke-free policy on SA Health staff, the Tobacco Control Research and Evaluation program is administering surveys to assess changes in smoking behaviour, perceived exposure to second-hand tobacco smoke, and attitudes towards the policy. Surveys of SA Health staff have been conducted at baseline and at three months post implementation, with a further follow-up survey planned at 12 months post implementation. A preliminary report analysis of the survey compared to baseline data is currently underway.

Evaluation of the Speaker’s Bureau bowel cancer presentations
The Speaker’s Bureau is a program which contracts paid speakers to conduct presentations to community and work groups on a range of cancer control topics. To evaluate one of the topic streams, ‘bowel cancer screening’, attendees were asked to participate in three surveys, before and after the presentation, and a telephone follow-up survey three months later. An interim study reporting selected results of the pre and post-presentation surveys was conducted.

Over the data collection period (April to July 2010) there were 295 attendees to 14 bowel cancer screening presentations. Response rates for the pre and post-presentation assessments were 88% and 83% respectively. The majority of attendees were female (80%) and were within the recommended age group for screening ie. 50 years and older (85%). Prior to the course, 66% of attendees reported they were aware of the Faecal Occult Blood Test (FOBT) (prompted awareness) at the pre-presentation assessment, and 28% of all attendees reported they had an FOBT in the last two years. The results suggested that attending a 45 minute presentation on bowel cancer screening had an immediate positive effect on attendees’ knowledge of the preventability of bowel cancer and their intentions to screen.

Centre for Behavioural Research in Cancer (CBRC), Victoria

Impact of publication of Australian treatment recommendations for DCIS on clinical practice: A population-based, before-after study
Ductal carcinoma in situ of the breast (DCIS) is a non-invasive disease considered a precursor to invasive breast cancer. Australian treatment recommendations for the management of DCIS were released in September 2003. To understand the influence of the treatment recommendations on surgeons’ management of DCIS, a population-based patterns of care study, was conducted. The study examined the clinical management of all new cases of pure DCIS diagnosed in Victoria in two 12-month periods: (i) immediately prior to the release of the recommendations (n=342; 97%); and (ii) three years after their release (n=371; 98%). Surgeons treating DCIS were also surveyed regarding their awareness of the treatment recommendations and their level of agreement with key recommendations (n=63; 58%).The proportion of cases undergoing image guided biopsy, or breast conservation surgery (BCS) did not change between surveys nor did extent of surgical margins. Compared to the baseline period, more BCS cases were referred to a radiation oncologist (67%/58%) and more received radiotherapy (53%/44%) post-treatment recommendations. With the possible exception of adjuvant radiotherapy, most cases of DCIS diagnosed in the year prior to the publication were treated according to recommendations. The increase in the use of radiotherapy for DCIS cases treated by BCS may reflect the influence of the treatment recommendations on this practice. However as only around half of BCS treated cases received radiotherapy in 2006/07, results also suggest there is some uncertainty among surgeons regarding the use of this therapy for all BCS treated cases. This paper has been published in the European Journal of Surgical Oncology.

Parent’s responses to nutrient claims and sports celebrity endorsements on energy-dense and nutrient poor foods: an experimental study
Food marketing techniques have come under scrutiny for their probable contribution to promoting unhealthy eating and childhood obesity. This study, aimed to explore parents’ responses to common strategies for marketing energy dense and nutrient poor (EDNP) child-oriented foods. A between-subjects online experiment tested whether nutrient claims and sports celebrity endorsements on the front-of-pack of EDNP foods led parents to prefer and rate these foods more favourably. A total of 1551 parents of children aged 5-12 years, who were the main household grocery buyers, were recruited from a national online panel. Results indicated parents were significantly more likely to prefer EDNP products if they included a nutrient claim or sports celebrity endorsement. Parents also perceived the promoted products to be more nutritious than those without promotions. Sports celebrity endorsements enhanced parent perceptions of typical consumers of the product, perceptions of product healthiness and quality, and purchase intentions. These findings indicate that parents are negatively influenced by the presence of nutrient claims and sports celebrity endorsements on EDNP food products. Consequently, efforts to reduce the persuasive impact of food marketing should focus on both parents and children. This paper is in press in Public Health Nutrition.

Centre for Behavioural Research in Cancer Control (CBRCC), Western Australia

Physical Activity and Nutrition for Seniors (PANS)
This National Health Medical Research Council funded project is a home-based program for insufficiently active adults aged 60 to 70 to increase levels of physical activity and improve dietary intake. The program is a 12 month RCT, based on the Social Cognitive Theory and the Precede-Proceed Model for seniors of low and medium socio economic status (intervention n=300; controls n=300) from 60 Perth suburbs. The six month intervention consisted of a booklet and supplementary materials (calendar, exercise chart, pedometer) providing dietary and physical activity information, and encouraging goal setting. Program group guides (consultants) provided regular specific advice and feedback to participants via telephone and email. Process evaluation was conducted, along with pre-post self-report data collected on psycho-social, physical activity, dietary and anthropometric measures and demographics. Process evaluation of the booklet and supplementary materials was very positive. Participants found the booklet easy to understand, liked its layout/appearance and found it motivating and encouraging. Participants used the calendar to record physical activity and found the exercise chart to be a visual reminder for the exercise program. The post-program evaluation is currently taking place via self-report questionnaires. Measures of physical activity and nutrition will be analysed, as well as the differences in the results between the intervention and control subjects.

Plain tobacco packaging research
Plain packaged cigarettes are scheduled to come into effect in Australia on 1 January 2012. The tobacco industry has funded, to the tune of $5 million, an umbrella organisation known as the ‘Alliance of Australian Retailers’ which purports to represent small tobacco retailers opposed to its introduction. Through mass media advertising, the alliance has argued that the implementation of plain packaged cigarettes will increase transaction times, errors made by shopkeepers and customer frustration, ultimately leading to smaller profits and loss of jobs. We are examining the validity of these claims by empirically testing transaction times with both coloured and plain cigarette packets. Data is currently being collected by observing the time taken for participants to select specified cigarette packets from both plain and coloured cigarette pack displays. On repeated occasions, each participant is asked to select a specific cigarette pack from a large display of either plain or coloured cigarette packs arranged in alphabetical order. Each ‘transaction’ is timed and any errors noted. Preliminary results suggest that there is little difference between the two pack types, plain packaging resulting in less errors.

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

CanChange study
The CanChange study is a randomised control trial of a telephone delivered intervention to improve lifestyle factors and overall quality of life for colorectal cancer survivors. Recruitment of participants commenced in February 2009 from the Queensland Cancer Registry and a final sample of 410 participants has been randomised to an intervention or ‘usual care’ control condition. The intervention focuses on symptom management, lifestyle and psychosocial support using telephone delivered health coaching sessions from a study-trained health professional (‘health coach’), additional educational resources, a pedometer and motivational postcards. Control participants receive standard Cancer Council educational materials. Intervention delivery for all participants was completed in October 2010. Baseline and six month data collection has been completed and follow-up data collection is ongoing, with final study results available in 2011.

CanPrevent study
Individuals with a family history of colorectal cancer have a significantly elevated risk of developing colorectal cancer. Epidemiological studies indicate that first degree relatives of survivors have a 1.6 to 8 times higher lifetime risk of colorectal cancer than those without a family history. CanPrevent is a telephone delivered lifestyle support program for first degree relatives of colorectal cancer survivors that aims to promote healthy lifestyle behaviours and screening uptake to assist participants reduce their cancer risk. The first phase of the study involves conducting two focus groups with first degree relatives of colorectal cancer survivors to gain insight into their knowledge of colorectal cancer, screening practices and motivations for making lifestyle changes. Phase 1 of the study has been completed and the findings will assist in the development of the program. The second phase will be conducted in early 2011 and involve a pilot study with n=20 participants. Participants will receive telephone-delivered health coaching sessions from a study-trained health professional (‘health coach’). Phase 2 of the study will test the acceptability and short-term effectiveness of the intervention.

Beating the Blues after Cancer study
The aim of the Beating the Blues After Cancer study is to assess the efficacy and cost-effectiveness of accessible and affordable psychological interventions for distressed cancer patients and carers. By comparing two different support options, the study will determine the best possible way to help people affected by cancer. The study began in September 2009 and recruitment was completed in August 2010, with 690 participants recruited from two helplines randomly allocated to one of two support options – five tele-based sessions with a psychologist or one tele-based session with a nurse counsellor. To date, 611 participants have completed their intervention sessions and this phase is scheduled for completion at the end of November. In addition, follow-up assessment is taking place at three, six and 12 months after initial assessment, comprising a short telephone interview and self-report survey. The final data collection phase is scheduled for completion by October 2011. Data cleaning of the baseline assessment data took place in September and the data is currently being analysed.

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