ABSTRACT Background This study aims to investigate survival outcomes among individuals with high‐risk, regional, and metastatic prostate cancer (PCa) by culturally and linguistically diverse (CALD) status in Victoria, Australia. Methods Individuals with high‐risk, regional, and metastatic PCa (February 2009–February 2024) registered in the Victorian Prostate Cancer Outcomes Registry (PCOR‐Vic), with last follow‐up on 31 July 2024. CALD status was derived from study participants' country of birth and subgrouped into: mainly non‐English‐speaking countries (NESC) (CALD backgrounds), mainly English‐speaking countries (MESC) outside Australia (MESC‐born), and Australia (reference group). The primary outcomes, all‐cause mortality (ACM) and PCa‐specific mortality (PCSM), were determined through linkage of PCOR‐Vic to Victorian Cancer Registry death data. ACM and PCa‐specific survival were estimated using Kaplan–Meier curves and the cumulative incidence function. Weibull parametric survival and Fine‐Gray competing‐risks regression models, adjusted for sociodemographic and clinical variables, assessed the association of CALD status with ACM and PCSM. Results Of 10,024 eligible participants, 32% died. The median survival time (death) was 116 months, and median follow‐up time (censoring) was 66 months. CALD individuals had lower 5‐year overall survival compared to Australian‐born individuals (66% vs. 71%). While unadjusted models suggested higher ACM among CALD individuals (adjusted hazard ratio [aHR] = 1.20, 95% confidence interval [CI] = 1.11–1.30), adjusted models showed lower ACM (aHR = 0.89, 95% CI = 0.82–0.97) and PCSM (adjusted subdistribution hazard [asHR] = 0.86, 95% CI = 0.76–0.96) than Australian‐born individuals. There were significant (p‐value < 0.05) interactions between CALD and age (older CALD individuals had higher hazard of ACM and PCSM) and CALD and PCa risk category (CALD individuals with regional PCa had higher hazard of ACM). Conclusions While CALD individuals had lower overall survival and higher ACM than Australian‐born individuals, CALD individuals exhibited lower ACM and PCSM following adjustments. Interactions of age and PCa risk category with CALD influenced mortality. Contributing factors (e.g., late diagnosis) should be addressed to reduce disparities by CALD status.

Abstract Background We conducted a qualitative study to examine what factors influence rural-residing people with cancer to participate in cancer clinical trials (CCT) and what factors influence their retention in CCT. Methods Purposive sampling was used to recruit participants from a regional cancer centre in Victoria, Australia, to participate in a semi-structured interview. Eligible participants were ≥ 18 years of age at the time of cancer diagnosis, newly consented to a clinical trial (< 1 year) or have been a trial participant for ≥ 1 year, lived in a non-metropolitan area classified within the Monash Modified (MM) Model 2–7 and able to provide informed consent. Thematic analysis was used to analyse the interview data. Results Seventeen participants were interviewed; 10 identified as female and seven as male. Participant’s ages ranged from 52 to 77 years, with a median age of 62 years. Eight participants had been on a CCT for ≤ 1 and 10 for ≥ 1 year. Factors that influenced their decision to participate in a CCT included trust and confidence in clinical trial staff, exposure to and trust in the experiences of cancer peers, altruism, low-risk trials and local access to trials. The factors influencing their decision to remain in a CCT included balancing the benefits and burdens of the trial, having no doubts about participating despite knowing the risks and seeing the personal benefits of participating in a CCT. Conclusion Our study shows that trust-based relationships, peer support, and altruism encourage rural residents to participate in CCT. To improve access to CCT for rural residents, a multi-faceted approach involving clinicians, health services, trial sponsors and policymakers is needed. These approaches must promote and facilitate the inclusion of diverse populations, prioritise CCT participation, and inform patients of CCT opportunities. We must recognise the knowledge and expertise of rural patients and caregivers and ensure they are involved as co-designers of future CCTs.

This study aimed to identify correlates of physical activity (PA) among rural Australian cancer survivors. A cross-sectional study was undertaken. We recruited a convenience sample of adults diagnosed with any cancer type who received care at a rural hospital in Gippsland, Victoria, Australia, between August 2017 and December 2021. PA was measured using the Godin–Shephard Leisure-Time PA Questionnaire (GSLTPAQ). Correlates of sufficient PA (total GSLTPAQ score ≥ 14), any mild PA (item-specific GSLTPAQ score > 0), and any PA (item-specific GSLTPAQ score > 0 for one or more intensities: mild, moderate and/or strenuous) were identified via binary logistic regression. There were 103 participants with a median age of 66 years. Among them, 35

INTRODUCTION:The Australian Cancer Plan prioritises individuals from culturally and linguistically diverse (CALD) backgrounds as a focus of interventions aimed at improving cancer care experiences and outcomes. We aimed to investigate differences in the National Comprehensive Cancer Network (NCCN) risk category classification at prostate cancer (PCa) diagnosis between CALD and non-CALD populations. METHODS:We included Victorian Prostate Cancer Outcomes Registry registrants with a PCa diagnosis (February 2009-August 2022) and country-of-birth data. CALD status was defined as birth in a mainly non-English-speaking country (CALD) versus Australia or a mainly English-speaking country (MESC). CALD individuals were further sub-grouped by preferred spoken language: English-speaking and non-English-speaking. We estimated the effect of CALD status on NCCN risk categories using partial proportional ordinal logistic regression. RESULTS:There were 25,951 individuals: 18,392 (71 %) Australian-born, 5046 (19 %) CALD and 2513 (10 %) MESC-born. Of 4872 CALD individuals with preferred-language data, 498 (10 %) preferred speaking a language other than English. Compared to Australian-born individuals, non-English-speaking CALD individuals presented with less low-risk (15 % vs 22 %) but more high-risk (32 % vs 21 %) and metastatic (18 % vs 8 %) disease. CALD individuals had significantly more advanced (regional or metastatic) disease than Australian-born individuals (adjusted odds ratio [aOR]=1.17, 95 % confidence interval [CI]=1.06-1.29). Non-English-speaking CALD individuals had significantly more advanced PCa (aOR=1.54, 95 % CI=1.23-1.94). CONCLUSIONS:Individuals from CALD backgrounds had greater odds of presenting with high-risk or advanced PCa. Improving early detection of PCa for CALD individuals requires investigation of underlying factors to plan effective interventions.

To examine associations between culturally and linguistically diverse (CALD) status and definitive treatment delay among individuals diagnosed with intermediate- or high-risk prostate cancer (PCa) in Victoria, Australia. Data were sourced from the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic). Individuals with index diagnoses of intermediate- or high-risk PCa (February 2009–August 2022) who were receiving PCa-directed definitive treatment (radical prostatectomy or radiotherapy) were included. CALD status was defined as being born in non-English-speaking countries versus mainly English-speaking countries (MESC) or Australia. Additionally, using preferred spoken language, CALD individuals were categorized into English-speaking CALD and non-English-speaking CALD individuals. Binary logistic regression was used to examine associations between CALD status and definitive treatment delay (> 90 days from diagnosis to treatment). Mediation analysis was undertaken using generalized structural equation modeling. Of 13,625 participants, 2,455 were from CALD backgrounds (18

PURPOSE:Oral anti-cancer medications (OAMs) are easily administered yet high-risk treatments. Few studies have investigated national and subnational trends in OAM dispensing. We aimed to examine 10-year trends in Australia's OAM dispensing at the national level as well as by state/territory and medication type/class. METHODS:Aggregate data on Australia's OAM dispensing and population for 2014-2023 were sourced from Services Australia and the Australian Bureau of Statistics, respectively. Annual OAM dispensing rates (counts per 100 000 population) were calculated overall as well as by state/territory and medication type/class. Percentage change (Δ) in dispensing rates from 2014 to 2023 was determined. Where valid, Mann-Kendall trend tests were performed. RESULTS:Australia-wide from 2014 to 2023, dispensing counts per 100 000 population for any OAMs increased nonlinearly from 3 475 to 3 930 (+Δ13%), hormonal OAMs decreased nonlinearly from 2 659 to 2 225 (-Δ16%), and non-hormonal OAMs exhibited a significant (p < 0.05) near-linear upward trend from 816 to 1 705 (+Δ109%). This coincided with a significant upward trend in the number of unique non-hormonal OAMs dispensed Australia-wide (+Δ187%). Percentage changes in non-hormonal OAM dispensing rates were greatest for protein kinase inhibitor (PKI) dispensing Australia-wide (+Δ232%), with a significant, near-linear upward trend from 286 to 950, and non-hormonal OAM dispensing in South Australia (+Δ141%), with a significant, near-linear upward trend from 820 to 1972. CONCLUSIONS:Australia's non-hormonal OAM dispensing increased over 2014-2023, mostly for PKIs. This likely reflects rising availability of and prescriber/patient demand for these medications, suggesting scope to pilot and expand OAM adherence and safety initiatives.

Men from culturally and linguistically diverse (CALD) backgrounds face challenges in accessing equitable and quality healthcare. However, little is known about the patterns of care among men diagnosed with prostate cancer (PCa) from CALD backgrounds. We aimed to map the available literature on patterns of care and treatment outcomes in men from CALD backgrounds who have PCa. We used the Johanna Briggs Institute scoping review methodology. We searched five bibliographic databases (Ovid MEDLINE, EMBASE, SCOPUS, CINAHL, and Ovid Emcare) and grey literature. We explored patterns of PCa care extending from screening and early detection to end-of-life care and treatment outcomes. A total of 7,148 records were identified; 58 studies were included. Most studies were from the United States (US) (n = 41) and used ethnic origin (n = 14), nativity (n = 10), immigration history (n = 11), or country of birth (n = 13) as indicators of CALD. Most studies focused on screening and early detection for PCa (n = 37), specifically prostate-specific antigen (PSA) testing. Twelve papers were on PCa treatment (e.g., surgery, radiation therapy, and active surveillance), five on follow-up and supportive care, and four on treatment outcomes (i.e., change in measured PSA and PCa cancer-specific survival). There were disparities in the PCa care continuum and treatment outcomes between CALD and non-CALD patients. Factors influencing screening and early detection for PCa were systematically summarised and most addressed individual-level determinants. Key findings from our scoping review emphasised the existence of guideline-discordant care, disparities in PCa screening test use, and differences in PCa treatment received among men from CALD backgrounds. However, little is known about patterns of care in diagnostic modalities, treatment phases, and palliative and end-of-life care.

Multiple frameworks describing optimal cancer survivorship care recommend the development of systems to monitor delivery of quality care. This study reports the experiences of cancer survivorship care in Australia and examines associations with patient-level sociodemographic and clinical characteristics. People aged ≥ 16 years, with any cancer receiving cancer care in a Victorian public hospital in 2018, were invited to complete a survey assessing care experiences. Seven items assessed follow-up care experiences with optimal care indicated by the response: ‘Yes, definitely received’, and sub-optimal care by responses ‘Yes, I think so’, ‘No’, and ‘Not sure’. A composite score was derived with optimal care defined as positive experiences on the majority of items. Sociodemographic and clinical factors associated with optimal care were examined using multivariable logistic regression. Of the 4998 (47

OBJECTIVE:Cancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location.METHODS:Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset.DESIGN:A cross-sectional study design was used.SETTING:CCTs were available Victoria-wide in 2018.PARTICIPANTS:There were 1669 CCTs and 5909 CCT participants.MAIN OUTCOME MEASURES:Rural CCT location was assessed as a binary variable with categories of 'yes' (modified Monash [MM] categories 2-7) and 'no' (MM category 1). MM categories were determined from postcodes. The highest ('least rural') MM category was used for postcodes with multiple MM categories.RESULTS:Of 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (p-value <0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (p-value <0.05) higher for non-industry than industry-sponsored trials.CONCLUSIONS:In Victoria, 10% of CCTs are at rural sites. Most rural-residing CCT participants travel to metropolitan sites, where there are more late-phase, non-solid-tumour and industry-sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.

This study aimed to explore levels of adherence to dietary guidelines, and factors associated with dietary guideline adherence, among rural Australian cancer survivors. A cross-sectional study was undertaken. We recruited a convenience sample of adults with cancer who attended the chemotherapy day unit or allied health appointments at a rural hospital in Baw Baw Shire, Victoria, Australia, between August 2017 and December 2021. Dietary guideline adherence was assessed by cross-referencing participants’ responses to an adapted version of the Dietary Questionnaire for Epidemiological Studies with dietary recommendations in Australian dietary guidelines. Binary logistic regression was used to assess factors associated with dietary guideline adherence for fruits and whole red meats. There were 107 rural cancer survivors (median age, 67 years). Dietary guideline adherence was highest for alcohol (88

BACKGROUND:While barriers to participation in physical activity are well documented, there is no consolidated evidence on strategies promoting participation of people with intellectual disability in physical activities.METHODS:We conducted a scoping review to examine initiatives used to facilitate the inclusion of people with intellectual disability in community-based sporting and recreation activities. We searched Medline, Embase, CINAHL+ and PsycINFO for articles published in English between 2000 and 2022.RESULTS:Eight articles were included. Initiatives included: (1) building knowledge, awareness and attitudinal change (2) organisational alliances/partnerships (3) relationship-building (4) modifications/adaptions to activities/environment (5) organisational policy (6) engagement with people with disability. Initiatives were implemented through international collaborations, in local fitness/recreational facilities and public spaces, and targeted athletes, coaches, volunteers and organisational leaders.CONCLUSION:While some increase in awareness and inclusion of people with intellectual disability was reported, no longitudinal data reported on the impact of initiatives on sustained social inclusion for people with intellectual disability.

We conducted a systematic review to describe health-related quality of life (HRQOL) in rural cancer survivors (RCS), and compare HRQOL between RCS and urban cancer survivors (UCS). We searched Medline, Embase, CINAHL Plus, and PsycINFO for studies with HRQOL in adult cancer survivors living in rural, regional, remote, and urban areas, who had completed definitive primary cancer treatment, without evidence of residual disease. Where available, we used normative and clinically important values to ascribe meaning to HRQOL data. Fifteen studies (16 papers) were included. Most were from the US (n = 8) and reported on breast cancer survivors (n = 9). Six HRQOL instruments, collecting data across 16 domains, were used. Three instruments were specific to the survivorship phase. Normative and clinical data were available for 12 studies. Compared with normative populations, RCS had clinically worse physical HRQOL (6/12 studies), better social/family (5/7), and functional (3/6) HRQOL, and there were no differences in emotional or/mental HRQOL (9/12). In six studies with rural–urban comparator groups and normative and clinically important data, RCS and UCS had clinically worse physical (3/6 and 2/6, respectively) and better social/family (3/4 and 2/4 studies, respectively) HRQOL than normative populations. Functional HRQOL was better in RCS (2/4 studies) than UCS and normative populations. In 3/6 studies, there were no clinical differences in emotional or/mental HRQOL between RCS, UCS, and normative populations. Overall, HRQOL is not clearly better or worse in RCS than UCS. Future research should include different tumor types, rural residents, and survivorship-specific HRQOL instruments.

Return to work (RTW) is a marker of functional recovery for working-age cancer survivors. Identifying factors that impact on RTW in cancer survivors is an essential step to guide further research and interventions to support RTW. This systematic review aimed to identify nontreatment, non-cancer-related variables impacting RTW in Australian cancer survivors. A systematic search was conducted in EMBASE, PsycINFO, CINAHL, PubMed, and Google Scholar. Studies were eligible if they included: (1) adults living post diagnosis of malignancy; (2) quantitative data for nontreatment, non-cancer-related variables impacting RTW; (3) only Australian participants. Included studies were critically appraised, and relevant data extracted and synthesized narratively. Six studies were included in the review, published between 2008 and 2020. Studies were of variable quality and mixed methodologies. One study included malignancies of any type with the remainder focusing on survivors of colorectal cancer (n = 3), oropharyngeal cancer (n = 1), and glioblastoma multiforme (n = 1). Multiple factors were related to RTW in individual studies, including older age, presence of three or more comorbidities, fewer work hours pre-morbidly, lower body mass index, longer than recommended sleep duration, and not having private health insurance; however, there was limited consistency in findings between studies. Other variables examined included: occupation type, household income, healthy lifestyle behaviors, flexibility, and duration of employment with workplace; however, no significant associations with RTW were reported. Further research is required to gather compelling evidence on factors that influence RTW in Australian cancer survivors.

A scoping review was conducted to explore the characteristics, barriers, and enablers of community engagement in place-based approaches to improving health outcomes in a designated area of poor health and disadvantage. The Joanna Briggs Institute methodology for scoping reviews was used. Forty articles met the inclusion criteria of which 31 were conducted in the United Kingdom, United States, Canada, or Australia, and 70% used qualitative methods. The health initiatives were delivered in multiple settings including neighbourhoods, towns, and regions and with a range of population groups including Indigenous and migrant communities. Trust, power, and cul-tural considerations were the most significant barriers and enablers to community participation in place-based approaches. Developing trust is key to success in community-led, place-based initiatives.

We aimed to describe physical activity (PA), obesity, and quality of life (QoL) among rural Australian cancer survivors, assess whether total and item-specific QoL are associated with sufficient PA and obesity, and assess whether PA and obesity interact with respect to QoL. In a cross-sectional study, convenience sampling was used to recruit adult cancer survivors via a chemotherapy day unit and allied health professionals at a rural hospital in Baw Baw Shire, Australia. Exclusion criteria were acute malnutrition and end-of-life care. PA and QoL were measured using Godin-Shephard and 7-item Functional Assessment of Cancer Therapy (FACT-G7) questionnaires, respectively. Factors associated with total and item-specific QoL were assessed via linear and logistic regression, respectively. Among 103 rural cancer survivors, the median age was 66 years, 35 =2.29; 95 =-2.09; 95

BackgroundThe assessment and management of pain and symptoms in community-based palliative care patients is a measure of quality in palliative care to indicate the quality of palliative care. Studies have identified rural community-based nurses are not always confident in this area of practice.AimTo identify rural community-based nurses’ strengths and gaps in palliative care knowledge and skills regarding pain, symptom and emergency management and to determine correlates of deficient knowledge.MethodsA cross-sectional study design was used. An electronic questionnaire was emailed to 165 community-based nurses in Gippsland, Australia. Participants rated their palliative care knowledge/skills on a five-point Likert scale ranging from ‘No knowledge’ (1) to ‘Can teach others’ (5) on the following topics: pain (2 items), medication (14 items), symptoms (26 items), palliative care emergencies (12 items) and assessment tools (2 items). For each item classified as a gap or consolidation, associations between nurse characteristics and no/basic knowledge were assessed using univariable and multivariable binary logistic regression.FindingsOverall, 122 nurses (response rate = 74%) completed the questionnaire. Seventy-one percent of items were identified as practice strengths. Strengths included pain (2/2), medication management (11/14), and symptom management (22/25). Twenty-nine percent of items were identified as gaps and consolidations. Gaps and consolidations related to management of opioid medications, symptom management of delirium, and the recognition and management of rare emergency situations within palliative care.DiscussionThis study found that lack of experience and formal training in palliative care were associated with gaps in knowledge.ConclusionThis study found that lack of experience and formal training in palliative care were associated with gaps in knowledge. Targeted interventions such as training and peer mentoring have the potential to address identified gaps in rural community-based nurses... palliative care knowledge/skills and, ultimately, improve the care of palliative patients.

Purpose To examine how socio-demographic, comorbidities and information needs influence quality of life (QoL) outcomes of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma. Methods Cross-sectional postal survey with eligible participants identified through a population-based cancer registry. QoL outcomes were assessed by EQ-5D-5L, social difficulties index (SDI) and, for those employed at diagnosis, current employment. Regression analyses explored associations between outcome variables and cancer type, age, time since diagnosis, residential location, socio-economic disadvantage, comorbidities and unmet information needs. Mediation analyses examined whether comorbidities and information needs explained relationships between outcome variables and socio-economic disadvantage. Results 2115 survivors participated. Mean EQ-5D-5L scores (mean = 0.84) were similar to population averages and SDI scores were low for the entire sample (mean = 3.80). In multivariate analyses, being aged over 80, greater socio-economic disadvantage, comorbidities and unmet information needs decreased EQ-5D-5L scores. Higher SDI scores were associated with socio-economic disadvantage, comorbidities and unmet information needs. Not being employed was associated with being aged over 50, more comorbidities and socio-economic disadvantage. Comorbidities but not information needs partially mediated the impact of socio-economic disadvantage on EQ-5D-5L and SDI accounting for 17% and 14% of the total effect of socio-economic disadvantage respectively. Neither comorbidities nor information needs mediated the association between socio-economic disadvantage and employment outcomes. Conclusions To improve quality of life, survivorship care should be better tailored to address the needs of individuals given their overall health and impact of comorbidities, their age and type of cancer and not simply time since diagnosis.