Cancer

Objectives Our goal was to explore and compare risk factors, patterns of management and survival outcomes in Indigenous compared with non-Indigenous Australian patients using the Victorian Lung Cancer Registry (VLCR).Study TypeA retrospective observational cohort study of the VLCR.SettingData collected from the VLCR between 18 January 2011 and 24 January 2024.ParticipantsPrimary lung cancer patients in the VLCR.Main Outcome MeasuresPatient, disease and management characteristics of Indigenous and non-Indigenous Australian patients. Impacts of patient and clinical variables on treatment and survival, measured by multivariable Cox regression and propensity-matched survival analysis.ResultsWe included 186 Indigenous and 17,439 non-Indigenous Australian patients. Indigenous Australian lung cancer patients were younger in age {median, 62 years (interquartile range [IQR], 55–69 years) vs. median, 71 years (IQR, 63–77 years); p < 0.001}, had lower socio-economic status (lowest quintile, 57 patients [31%] vs. 3274 patients [19%]; p < 0.001), were more likely to be current smokers (118 patients [65%] vs. 5963 patients [35%]; p < 0.001) and had higher levels of respiratory comorbidity (64 patients [34%] vs. 4088 patients [23%]; p < 0.001). There were no statistically significant differences in receipt of guideline-concordant treatment (82 patients [51%] vs. 8036 patients [56%]; p = 0.12) and survival outcomes (median survival, 1.4 vs. 1.5 years; hazard ratio, 1.06 [95% confidence interval, 0.88–1.27]).ConclusionWe found lung cancer patients of Indigenous status were more likely to have demographic disadvantage and clinical risk factors that may contribute to discrepancies in management compared with patients of non-Indigenous status. Identifying barriers to healthcare and treatment in the Indigenous Australian population is an important research priority to improve disparities between the two populations.

Melanie Wong, Mike Lloyd, Jessie Zeng, Sanuki Tissera, Kalinda E. Griffiths, Justine Clark, Jonathan Gillies, Lisa Briggs, Jacqueline Lesage, Tom Wood, Craig Underhill, Sagun Parakh, Louis B. Irving, Wasek Faisal, Rob Blum, Gary E. Richardson, Phillip Parente, Michelle Caldecott, Inger Olesen, Javier Torres, Evangeline Samuel, Christopher Lyne, Katharine See, David Langton, Thomas John, Gavin Wright, Matthew Conron, James Bartlett, Golsa Adabi, Maggie Moore, Susan Harden, Zoe K. McQuilten, John R. Zalcberg, Rob Stirling

Cancer remains a global health challenge, with rising survivorship rates highlighting the need for integrated interdisciplinary rehabilitation care. Survivors frequently experience persistent physical, functional, psychological, cognitive and behavioural challenges, including fatigue, deconditioning, neuropathy, pain and psychological distress, with up to two-thirds reporting significant unmet needs and reduced quality of life. Interdisciplinary rehabilitation, encompassing exercise, education, nutrition, task-specific functional retraining, psychosocial support and vocational interventions, effectively mitigates these disabilities, improving function and promoting societal participation. Despite strong evidence, rehabilitation remains underutilised in Australia and New Zealand due to workforce, infrastructure, referral, funding and awareness barriers. Embedding rehabilitation as standard cancer care is essential to optimise survivorship outcomes and deliver sustainable health system benefits.

Krystal Song, Steven G. Faux, Fary Khan

Lung cancer remains Australia's leading cause of cancer death, with a disproportionately high burden on Aboriginal and Torres Strait Islander peoples. The recent launch of the National Lung Cancer Screening Program (NLCSP) offers an exciting and critical opportunity to improve outcomes. However, the program's full potential may not be met due to substantial systemic shortfalls. Key challenges include inadequate access to multidisciplinary workforce, limited access to personalised medicine and a lack of a national clinical quality registry. To maximise the NLCSP's impact, strategic investment is urgently needed to strengthen clinical infrastructure, enhance research and ensure equitable access to care.

Fraser J. Brims

Melanoma represents a significant burden on the Australian healthcare system and early detection is crucial to improve patient and health system outcomes. Experts suggest that targeted screening for high-risk individuals could lead to more efficient use of healthcare resources. Integrated risk scores combine polygenic risk scores (PRS) and non-genetic risk factors to offer the best performance for melanoma risk stratification. However, the feasibility of using integrated risk scores on a population basis to identify those at highest risk has yet to be evaluated. This narrative review aimed to identify evidence gaps and key issues to be addressed to support implementation of melanoma integrated risk scores on a population-based scale in Australia. Findings highlighted the following research and infrastructure needs: understand the progression rate of melanoma in situ to invasive disease; define who should be offered integrated risk scores; address performance issues across ancestries; develop clearly defined risk thresholds and corresponding clinical advice; and investigate clinical utility and impact of receiving integrated risk scores. Furthermore, screening programmes will require: equitable access to post-screening care; guidelines and quality standards for generating PRS and integrated risk scores; healthcare rebates for PRS testing; infrastructure for computational and data storage needs; workforce training and clinical decision support resources; clearer protections around PRS use in risk-rated insurances; and clear plans for programme quality and performance management. In conclusion, integrated risk scores have potential to facilitate targeted high-risk melanoma screening in Australia. However, there are significant evidence and infrastructure gaps that must be addressed before programme implementation.

Courtney K. Wallingford, Chloe Mighton, Tamara Dawson, Anne Cust, H. Peter Soyer, Yvonne Bombard, Tatiane Yanes, Aideen McInerney-Leo

ObjectiveTo examine the features of interval colorectal cancer (interval CRC) in Western Australia in the context of the National Bowel Cancer Screening Program (NBCSP), including incidence, characteristics and survival by NBCSP participant characteristics.Study DesignRetrospective observational cohort study, analysis of linked National Cancer Screening Register and Western Australian Cancer Registry data.Participants, SettingParticipants in the Western Australian NBCSP (50–74years of age) with negative immunochemical faecal occult blood test (iFOBT) results during the 2018 screening round (1 January 2018–31 December 2018) were followed up for interval CRC diagnoses until 31 December 2020, and for death until 30 September 2022.Main Outcome MeasuresCrude and adjusted incidence rates of interval CRC were analysed overall and by sex, age group and residential socio-economic and remoteness categories. Survival outcomes for people with interval CRC were also assessed.ResultsOf 122,851 NBCSP participants with negative screening results in 2018, 51 people were diagnosed with interval CRC during follow-up (crude incidence rate, 21 per 100,000 person-years; 95% confidence interval [CI], 16–27). The adjusted incidence rate ratio of interval CRC was higher for men than women (adjusted incidence rate ratio [aIRR], 5; 95% CI, 3–11) and for people aged 70–74years than for those aged 50–59years (aIRR, 3; 95% CI, 1–6). Nineteen of 51 interval CRCs were diagnosed 19–24months after negative iFOBT results, 25 were located on the right side of the colon and 34 were adenocarcinomas. Only 13 interval CRCs were stage I tumours at diagnosis. During follow-up (median, 33months; interquartile range, 28–42months), the all-cause mortality rate among the 51 people with interval CRC was 41 per 1000 person-years (95% CI, 18–92), and the colorectal cancer mortality rate was 35 per 1000 person-years (95% CI, 14–83).ConclusionsWe provide a comprehensive analysis of interval CRC staging and clinical characteristics in the context of the NBCSP in Western Australia, facilitating the definition of benchmarks for monitoring programme performance.

Shantelle J. Smith, Rachael Moorin, Dagmawi Tadesse, Kathleen O'Connor, Thi Ninh Ha

ObjectivesTo determine how many people who die of cancer in Victoria receive palliative care and early palliative care (more than 3months before death); to assess the impact of early palliative care on the quality of end-of-life care.Study DesignRetrospective, population-based cohort study; analysis of linked Victorian Cancer Registry data and routinely collected data for inpatient, non-admitted health service and emergency department care during the 12months prior to death.Setting, ParticipantsVictorian adults who died of cancer during 1 January 2018–31 January 2023.Main Outcome MeasuresProportions of people who received palliative care (any time) or early palliative care (more than 3months prior to death); likelihood of quality of end-of-life care measures: dying outside an acute hospital; chemotherapy, two or more emergency department visits, two or more hospital admissions during final 30days of life; advance care plan at death.ResultsOf 53,305 people who died of cancer (mean age, 74.8years [standard deviation, 13.0years]; 29,527 men [55.4%]), palliative care was provided for 38,697 (72.6%); 17,409 people (32.7%) received early palliative care. The most frequent palliative care type was palliative approach to care (Z51.5 code; 33,974 people, 63.7%). The overall proportion of people who received palliative care did not change markedly during 2018–2022; the proportion who received early palliative care declined slightly, from 34.8% (95% confidence interval [CI], 33.6–35.9) to 33.0% (95% CI, 31.7–33.8). People who received early palliative care were more likely than people who received late palliative care to have an advance care plan (adjusted odds ratio [aOR], 1.46; 95% CI, 1.38–1.55) and to die outside hospital (aOR, 2.50; 95% CI, 2.37–2.64); they were less likely to have two or more of emergency department presentations (aOR, 0.75; 95% CI, 0.70–0.81), two or more hospital admissions (aOR, 0.58; 95% CI, 0.55–0.61) or chemotherapy (aOR, 0.51; 95% CI, 0.47–0.55) during their final 30days of life.Conclusion72.6% of people who died of cancer in Victoria during 2018–2023 had received palliative care, but only 33% had received it early. End-of-life care may be improved by providing palliative care early. The low early palliative care rate, despite the potential for improved outcomes for people who receive it, indicates that action is needed.

Chris Schilling, Olivia Wawryk, Anna Collins, Vijaya Sundararajan, Brian H. Le, Jennifer Philip

By quantifying the impact of geographical disparities in cancer survival, these findings highlight the need for evidence-based interventions to improve cancer survival across Australia

Charlotte K Bainomugisa · Jessica Cameron · Paramita Dasgupta · Peter Baade

David M Roder

Rachel Farber · Nehmat Houssami · Katy J L Bell

People experiencing homelessness should be prioritised in national cancer plans and policies to promote equitable access to cancer care and the health care system more broadly

Amy Stearn · Jennifer A Baldock · Julia N Morris · Joanne Flavel · Fran Baum

Overview of lung cancer biobanking globally and in Australia, challenges such as difficulty with tissue acquisition, the usefulness of biospecimens in multi-omic analysis, as well as unique challenges faced in Australia

Sarah Yeo · Stephen Q Wong · Farzaneh Atashrazm · Andreas Behren · Anthony T Papenfuss · Natalia Vukelic · Lisa Briggs · Ashleigh R Poh · Daniel Steinfort · Natasha Smallwood · Kate Sutherland · Vivek Naranbhai · Sagun Parakh · Tracy Leong

Oyedeji Ayonrinde · Sara Mohamed · Jenna Nensi

Introduction of five key actions for Australia to reduce hepatocellular carcinoma mortality through increasing liver cancer surveillance uptake

Jess Howell · Jon D Emery · Stuart Roberts · Alexander J Thompson · Michael Ng · Jacob George · Barbara A Leggett · Edmund Tse · Bella Nguyen · Troy Combo · Alan J Wigg

The core elements of a First Nations cancer care coordination role developed by iterative yarning with First Nations stakeholders, audits of current care, and recommendations from existing patient coordinator programs

Mollie C Wilson · Marissa Mulcahy · Jennifer Philip · Brian H Le · Gail Garvey

The NLCSP provides a timely opportunity to improve health outcomes for Aboriginal and Torres Strait Islander peoples. However, it is critical that the program is tailored to the needs of each community and upholds rights to self-determination to be successful

Tanika L Ridgeway (Worimi) · Kayden Roberts‐Barker (Wiradjuri) · Kade Booth · Michelle Kennedy (Wiradjuri)