Cancer

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Nicola Creighton · Richard Walton · David M Roder · Sanchia Aranda · Arthur J Richardson · Neil Merrett · David Currow

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Helen Zorbas

Better targeted therapies will reduce the burden of treatment, while improving the outcomes

Ian N Olver

Although evidence for increasing incidence has not yet been reported, we should be vigilant

Moe Kyaw · Joseph JY Sung

A comprehensive evidence base for informing efforts to improve services requires linked national data

David M Roder · Elizabeth Buckley

The excess burden of cancer among Indigenous people will persist until lifestyle risks are mitigated

John R Condon · Xiaohua Zhang · Karen Dempsey · Lindy Garling · Steven Guthridge

Location of residence may negatively influence the quality of care received by patients with pancreatic cancer

Elizabeth A Burmeister · Dianne L O'Connell · Susan J Jordan · David Goldstein · Neil Merrett · David K Wyld · Vanessa L Beesley · Helen M Gooden · Monika Janda · Rachel E Neale

The incidence of CRC in people under 50 in NSW was steady during 2001–2008

Stephen Boyce · Natasha Nassar · Cathy Yuen Yi Lee · Michael KL Suen · Saleh Al Zahrani · Marc A Gladman

Meeting supportive care needs is key to maximising patients’ quality of life and minimising recurrence

Nicholas Zdenkowski · Stephanie Tesson · Janine Lombard · Melanie Lovell · Sandra Hayes · Prudence A Francis · Haryana M Dhillon · Frances M Boyle

Modifiable lifestyle factors may reduce the risk of developing breast cancer. Obesity is associated particularly with post-menopausal breast cancer. Diet is important, and exercise equivalent to running for up to 8 hours each week reduces the risk of breast cancer, both in its own right and through reducing obesity. Alcohol consumption may be responsible for 5.8% of breast cancers in Australia and it is recommended to reduce this to two standard drinks per day. Drinking alcohol and smoking increases the risk for breast cancer and, therefore, it is important to quit tobacco smoking. Prolonged use of combined oestrogen and progesterone hormone replacement therapy and oral contraceptives may increase breast cancer risk and this must be factored into individual decisions about their use. Ionising radiation, either from diagnostic or therapeutic radiation or through occupational exposure, is associated with a high incidence of breast cancer and exposure may be reduced in some cases. Tamoxifen chemoprevention may reduce the incidence of oestrogen receptor positive cancer in 51% of women with high risk of breast cancer. Uncommon but serious side effects include thromboembolism and uterine cancer. Raloxifene, which can also reduce osteoporosis, can be used in post-menopausal women and is not associated with the development of uterine cancer. Surgical prophylaxis with bilateral mastectomy and salpingo-oophorectomy can reduce the risk of breast cancer in patients carrying BRCA1 or BRCA2 mutations. For preventive treatments, mammographic screening can identify other women at high risk.

Ian N Olver

New immunotherapies are helping in the fight against advanced cancers but also present new adverse event management challenges

Jack M Bourke · Michael O'Sullivan · Muhammad A Khattak

Australia has a good record in reducing cervical cancer rates — but strategies must change with new knowledge

Jonathan Carter

The program has had substantially reduced the overall incidence of cervical cancer in women aged 25 and over

Megan Smith · Karen Canfell

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Clare M McNally · Sharon Liberali

Cancer Australia, in collaboration with leading national, state and territory health organisations and governments, has begun the ambitious STaR project to access and report national data on cancer Stage at diagnosis, Treatment and Recurrence. The project will greatly enhance our ability as a nation to understand variations in cancer outcomes by stage and treatment across population groups. While cancer registries based on the Australian population have been collecting and reporting high-quality data on cancer incidence and mortality for at least 30 years, there remains a lack of national data on the stage (severity of a cancer) when a patient is first diagnosed, the treatments subsequently applied and the frequency of cancer recurrence after treatment. The successful collection and reporting of STaR data, along with information already being collected on cancer incidence and mortality will provide, for the first time, important information across the journey of patients with cancer. With a better understanding of cancer outcomes by stage and treatment across population groups, we can more accurately address variations in practice. This will be especially valuable in variations in outcome across socio-demographic and culturally and linguistically diverse groups. The data may also assist in determining whether differences in survival can be explained by the treatment provided and patterns of care following diagnosis, which could identify areas for practice improvement. The knowledge gained will inform clinical best practice in cancer control, health services planning and public health policy. The STaR project will initially collect and report on the five cancers of highest incidence in Australia. Where available, data will be analysed by cancer type (site and histology), age and gender, Indigenous status, remoteness, socio-economic status and country of birth. In undertaking the STaR project, Cancer Australia is engaging with state and territory population-based cancer registries, as well as key cancer control stakeholders, including the Australian Institute of Health and Welfare, the Australasian Association of Cancer Registries and state and territory government health departments.

Elizabeth Coad

Most cases can be diagnosed by good clinical assessment at the bedside

Martin Veysey

The speed with which patients are referred to specialists depends on the cancer type

Karen Lacey · James F Bishop · Hannah L Cross · Patty Chondros · Georgios Lyratzopoulos · Jon D Emery

Financial toxicity in clinical care today: a “menu without prices”1

Out-of-pocket costs are rising rapidly and can influence treatment decisions and health outcomes

David Currow PhD, FRACP, FAHMS · Sanchia Aranda PhD, MN, BAppSci

Supportive care encompasses managing symptoms and side effects before, during and after cancer treatment

Ian N Olver MB BS, MD, PhD

Improvements in survival and cancer-related symptoms must be weighed up against treatment-related adverse effects and financial burden

Nicola J Lawrence BHB, MB ChB, FRACP · Glenn Salkeld PhD, MPH, GradDipHealthEcon · Martin R Stockler MB BS, FRACP, MSc(ClinEpi) · Deme Karikios BSc, MB BS, FRACP

About 450 000 individuals in Australia may be eligible for lung cancer screening

David Manners MB BS(Hons) · Jennie Hui PhD · Michael Hunter PhD(Dist) · Alan James MB BS, FRACP, PhD · Matthew W Knuiman PhD · Annette McWilliams FRACP, FRCPC, MD · Siobhain Mulrennan MRCP, MD, FRACP · Arthur W (Bill) Musk MB BS, MD, FRACP · Fraser JH Brims MD, MRCP, FRACP

Clearer definitions will help improve quality of care and reduce variation in patient outcomes between centres

Robert C Gandy MB ChB, MS, FRACS · Andrew P Barbour MB BS, PhD, FRACS · Jaswinder Samra DPhil, FRCS(Eng), FRACS · Mehrdad Nikfarjam MB BS, FRACS, PhD · Koroush Haghighi MB BS, FRACS · James G Kench MB BS, FRCPA · Payal Saxena FRACS, PhD · David Goldstein MB BS, FRCP[UK], FRACP

We have the will to improve cancer services for patients outside major cities but, thus far, not the way

Elizabeth Tracey BSc(Hons), MPH, PhD · Brian C McCaughan MB BS, FRACS · Jane M Young MPH, PhD, FAFPHM · Bruce K Armstrong MB BS(Hons), DPhil, FRACP