BACKGROUND:Depression is common among older adults with cancer. The USA-developed CARE (Cancer and Ageing: Reflection for Elders) psychotherapy intervention, specifically addresses the unique needs of older people (≥ 70 years) navigating the challenges of ageing, depression, and cancer. AIMS:To review and tailor the CARE resources to ensure they are culturally appropriate and acceptable for older Australians. METHODS:Semi-structured cognitive 'think aloud' interviews were conducted with older Australians (≥ 70 years) diagnosed with cancer. Participants reviewed the intervention resources for each session providing feedback on content relevance and understandability. Content analysis was used to analyse the interviews. RESULTS:We completed 20 cognitive interviews. Participants had a mean age of 74 years (range 70-79) and most with a diagnosis of blood (55% n = 11) or breast cancer (45%, n = 9) within 10 years. Resource content resonated with participants and a telephone-delivered intervention was acceptable. Participants emphasised the need to simplify wording and modify language to reflect Australian culture. In Australia 'elders' is a cultural term used by First Nations peoples to identify a custodian of knowledge; most participants suggested changing this. For some participants, the analogy of ageism to racism used felt unfamiliar. CONCLUSIONS:This study highlights that cultural adaptation of psycho-oncology interventions is required, even between English-speaking countries, to ensure cultural appropriateness and enhance feasibility, acceptability and to maximise uptake for older adults facing cancer and depression.

People with primary brain tumor (PBT) and their families experience high distress and face challenges navigating their disease and treatment, healthcare systems, and/or survivorship. Quality brain tumor care coordination (BTCC) enables continuous, timely care according to the individual care needs of patients. We aimed to explore healthcare professionals’ (HCPs) practices and perceptions of BTCC. We conducted semi-structured interviews with 12 HCPs (92

INTRODUCTION:Gastrointestinal cancer surgery commonly leads to postoperative complications and other adverse outcomes. While prehabilitation shows promise in reducing adverse postoperative outcomes, most hospitals have resource limitations that preclude its use as standard of care. Additionally, the need to expedite surgery from diagnosis often creates a narrow window for prehabilitation initiatives. Online, self-reported screening tools may address these challenges by facilitating early identification of high-risk patients and enabling targeted preoperative interventions, thereby allowing equitable allocation of limited resources. Therefore, the primary aim of this study is to evaluate the predictive utility of a tri-modal (physical, nutritional, psychological) screening tool for patients undergoing gastrointestinal cancer surgery. METHODS:This prospective international cohort study will recruit 1214 adults undergoing elective gastrointestinal cancer surgery across 35 sites from 19 countries. Participants will complete an online screening tool developed through a comprehensive, multistep, predefined process. The screening tool comprises the Duke Activity Status Index, Patient-Generated Subjective Global Assessment Short Form and the Patient Health Questionnaire-4, in English, Spanish, French or Portuguese. These tools were selected based on a scoping review, followed by an international Delphi consensus process. The primary outcomes include rate of postoperative complications, major complications (Clavien-Dindo Classification grade III-V) and overall complication severity assessed by the Comprehensive Complications Index; all assessed 30 days postoperatively. Secondary outcomes include hospital length of stay, readmission rate within 30 days, discharge destination (home vs other), days at home and alive in 30 days postsurgery, 30-day all-cause mortality and 12-month survival. Primary analyses will establish optimal screening tool cut-points to stratify patients into clinically actionable risk categories for postoperative complications and examine the independent predictive value of these screening scores after adjusting for established clinical risk factors. ETHICS AND DISSEMINATION:This study has received ethical approval from the Sydney Local Health District Human Research and Ethics Committee (X25-0333 and 2025/ETH02465) and has been registered on the Open Science Framework (10.17605/OSF.IO/HVCGD). The results of Preoperative Risk Evaluation for Cancer Treatment will be submitted to reputable journals and presented at national and international conferences.

Background Managing brain tumor-related personality and behavior changes (BTrPBc) is complex with contributors including tumor location, type, and grade; treatment side effects; and psychological adjustment to a primary brain tumor diagnosis. Although carers of people with high-grade glioma consistently report BTrPBc as an area where they require support, there is a lack of guidelines for healthcare professionals to address BTrPBc. We aimed to explore how neuro-oncology healthcare professionals manage personality and behavior changes in adults with a primary brain tumor.Methods This study used an interpretive description approach. Semi-structured interviews were conducted with healthcare professionals practicing in neuro-oncology across Australia via face-to-face, telephone, and video conference. Codebook thematic analysis methods were used.Results Healthcare professionals (N = 22) from a range of medical and allied health disciplines participated in interviews with an average duration of 34 minutes. Four themes described how healthcare professionals seek to manage patients' personality and behavior changes: (i) Building trusting relationships, (ii) What is this brain's story?, (iii) Brief intervention; and (iv) Targeted intervention. Sub-themes were developed within each theme.Conclusions Our results highlight the diverse support healthcare professionals provide for the management of BTrPBc. There is a need for interventions to be formulation-driven, involve individualized care, provide education, and focus on the patient-carer dyad. A stepped-care approach to managing BTrPBc is recommended; however, further evaluation in clinical practice is necessary.

BACKGROUND:Preclinical and observational studies suggest that exercise may improve cancer outcomes. However, definitive level 1 evidence is lacking. METHODS:In this phase 3, randomized trial conducted at 55 centers, we assigned patients with resected colon cancer who had completed adjuvant chemotherapy to participate in a structured exercise program (exercise group) or to receive health-education materials alone (health-education group) over a 3-year period. The primary end point was disease-free survival. RESULTS:From 2009 through 2024, a total of 889 patients underwent randomization to the exercise group (445 patients) or the health-education group (444 patients). At a median follow-up of 7.9 years, disease-free survival was significantly longer in the exercise group than in the health-education group (hazard ratio for disease recurrence, new primary cancer, or death, 0.72; 95% confidence interval [CI], 0.55 to 0.94; P = 0.02). The 5-year disease-free survival was 80.3% in the exercise group and 73.9% in the health-education group (difference, 6.4 percentage points; 95% CI, 0.6 to 12.2). Results support longer overall survival in the exercise group than in the health-education group (hazard ratio for death, 0.63; 95% CI, 0.43 to 0.94). The 8-year overall survival was 90.3% in the exercise group and 83.2% in the health-education group (difference, 7.1 percentage points; 95% CI, 1.8 to 12.3). Musculoskeletal adverse events occurred more often in the exercise group than in the health-education group (in 18.5% vs. 11.5% of patients). CONCLUSIONS:A 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival and findings consistent with longer overall survival. (Funded by the Canadian Cancer Society and others; CHALLENGE ClinicalTrials.gov number, NCT00819208.).

PURPOSE:Informal caregivers of people with high grade glioma (HGG) often have high levels of unmet support needs. Routine screening for unmet needs can facilitate appropriate and timely access to supportive care. We aimed to develop a brief screening tool for HGG caregiver unmet needs, based on the Supportive Care Needs Survey-Partners & Caregivers (SCNS-P&C). METHODS:Secondary analysis was performed on responses to the SCNS-P&C from 188 HGG caregivers, who participated in the Care-IS trial. SCNS-P&C items were assessed against four criteria: factor loadings; prevalence; variation in domain score; diagnostic accuracy. Supplementary analysis was conducted at two timepoints (T1 & T2) on the final selected items to identify caregivers indicating no needs on the screening items but reported a need on the original SCNS-P&C, suggesting they would be "missed" by the screening items. RESULTS:Six items performed best against psychometric criteria, capturing two domains: Cancer impact needs and Information and communication needs. Supplementary analysis showed screening items failed to identify only 7.4% (14/188) of caregivers with other unmet needs at T1 and 11.4% (18/158) at T2. Of those missed at T1, only four were missed again at T2. CONCLUSIONS:We identified six-items for inclusion in a brief screening tool, the SCNS-P&C-6, demonstrating good sensitivity in detecting unmet needs of caregivers of people with HGG. Use of this tool in clinical practice has the potential to improve access to care and the cancer experience for both the caregiver and person with brain tumor.

Increasing survival rates have left many leukaemia survivors with debilitating effects from the disease and its treatments. However, little is known about the persistent unmet needs of people living with leukaemia. We aimed to qualitatively explore the experiences of individuals living with leukaemia and suitability of the Clinical Oncology Society of Australia’s (COSA) Model of Survivorship Care (2016) to reflect leukaemia survivorship. We used an inductive qualitative approach, conducting semi-structured interviews with leukaemia survivors recruited via social media and cancer advocacy organisations. Interviews were continued until information power was deemed appropriate. Reflexive thematic analysis (RTA) was used to describe and interpret key themes and meta-themes in the data. Overall findings were examined alongside the COSA Model. Twenty-four leukaemia survivors were interviewed; six themes were identified: (1) leukaemia is impactful, life-altering, and unexpected; (2) leukaemia is enduring, life-limiting, and uncertain; (3) survivorship is a team effort; (4) centrality of work as identity, focus, and financial security; (5) the dynamic landscape of coping; and (6) survivorship as adjusting. Overall, participants described leukaemia survivorship as (1) recursive and (2) holistic. Our findings, while broadly corresponding with the COSA Model, demonstrate it lacks nuances specific to leukaemia survivorship. We recommended the HMLS be used to guide future leukaemia-specific development of the COSA Model and survivorship services. We identified key domains and stages common across leukaemia survivorship, presented in our proposed Holistic Model of Leukaemia Survivorship (HMLS), addressing these domains are critical to the provision of quality survivorship care.

TPS298 Background: The backbone of prostate cancer systemic treatment is androgen deprivation therapy (ADT) increasingly with the use of androgen receptor pathway inhibitors (ARPIs). Mechanisms for ARPI resistance include amplification of the androgen receptor (AR), overexpression of AR variants, aberrant AR activity, and autocrine/paracrine androgen synthesis in tumour cells. Preclinical and clinical studies have identified that bipolar androgen therapy (BAT) may restore the sensitivity of prostate cancer to ARPIs. We plan to test this hypothesis in patients with PSA progression on darolutamide for non-metastatic castrate resistant prostate cancer. Methods: WOMBAT (ANZUP 2201, NCT06594926, ACTRN12624000582550) is a single-arm phase 2 trial. The primary endpoint is to determine metastasis-free survival (MFS; time from commencing BAT to evidence of metastases or death, by conventional imaging as per PCWG3 criteria). Secondary endpoints include toxicity of BAT and darolutamide; effects on health-related quality of life; efficacy measures (PSA response rate; PSA progression-free survival); effects of BAT and darolutamide on bone turnover. Inclusion criteria include: PSA progression on darolutamide for nmCRPC; M0 on conventional imaging. Treatment consists of BAT (IM testosterone enanthate 500mg) day 1 and darolutamide 600mg bd days 29-56 (of a 56-day cycle) with ongoing ADT. The total sample size of 69 (with a first stage of enrolment of 44) is calculated to demonstrate an increase in the proportion of participants without detectable metastases at 6 months from 56.1% to 66.7% (corresponding to a median MFS improvement from 7.2 to 10.27 months, HR 0.6) with a one-sided type I error of α = 10% and power of 80%, based on benchmarks from the ARAMIS trial of darolutamide in nmCRPC. Enrolment has commenced at 8 sites around Australia. Clinical trial information: ACTRN12624000582550 .

Androgen deprivation therapy (ADT) for prostate cancer adversely affects quality of life. Whilst exercise is effective for ameliorating many side effects, most people are inactive, with lack of motivation a key barrier. Self-determination theory (SDT) specifies the quality, rather than quantity, of motivation as essential for optimal engagement. We aimed to explore exercise motivation in men on ADT through the theoretical lens of SDT. As part of a mixed-method longitudinal study, semi-structured interviews exploring exercise behaviour and perceptions, were conducted with people receiving ADT for prostate cancer. Thematic analysis identified motivation themes aligned with SDT concepts. Twenty-four men participated (median age 74 years; ECOG 0: 92

This study aimed to (i) identify how carers and healthcare professionals define and describe brain tumour–related personality and behaviour changes in adults and (ii) explore the impact of these changes on family carers. We conducted 22 semi-structured interviews with neuro-oncology healthcare professionals working in Australia and 13 interviews with current or bereaved carers in Australia and Denmark. Definition data were analysed deductively using the Diagnostic and Statistics Manual of Mental Disorders 5th Edition Text Revision (DSM-5-TR) Personality Change Due to Another Medical Condition diagnostic criteria, and inductively to uncover new ideas related to descriptions of brain tumour–related personality and behaviour changes perceived by carers and healthcare professionals. Inductive thematic analysis was conducted to develop themes exploring the impact of patient personality and behaviour changes on carers. Two themes were identified from participants’ description of personality and behaviour changes associated with brain tumours: (i) variable presentation and multifactorial aetiology and (ii) manageable versus challenging changes. The specific features and symptoms of personality and behaviour changes reported by the sample are presented alongside the DSM-5-TR features of Personality Change Due to Another Medical Condition for clinical utility. Three themes were identified related to the impact of patient brain tumour–related personality and behaviour changes on carers: (i) grieving the person: “I don’t know who this person is anymore”; (ii) bearing the brunt of behavioural changes: “Happening behind closed doors”; and (iii) safety concerns and aggression: “I didn’t know what was going to happen next”. The three main themes were further elaborated through corresponding subthemes. This study highlights the nuances and complexity in conceptualising personality changes in patients with a brain tumour and the grief, isolation, and safety concerns experienced by carers. Brain tumour–related aggression was identified as a significant concern by both healthcare professionals and carers, lacking clinical guidelines internationally for managing violence and aggression in this population. Future research is required to test interventions and support for safeguarding and risk management for patients and their family members.

For people with primary brain tumors (PBT) and their carers, care coordination (CC) offers comprehensive, timely, person-centered care. This review aimed to systematically scope the breadth of literature relevant to approaches to CC for PBT. Four databases were searched (PubMed, PsycINFO, EMBASE, and CINAHL) for empirical research, and gray literature was searched for doctoral theses, clinical guidelines, and education resources for healthcare professionals (HCPs) related to the concept/model of CC in neuro-oncology. Data were systematically evaluated and synthesized following PRISMA-SCR guidelines. From 1163 screened abstracts, 30 eligible reports were reviewed (13 addressed CC interventions, 9 narrative reports, 5 describing CC/navigator positions, and 3 clinical guidelines). Most reports described nurse-led models of care within single tertiary care centers in metropolitan settings: a single HCP acting as primary contact, educator, and liaison, screening patient/carer distress and providing referrals as key components of CC. Clinical guidelines emphasize healthcare system navigation and access to medical care in CC. A CC approach overseeing the whole PBT trajectory was lacking. Facilitators of CC included availability of HCP dedicated to CC; HCPs' competency in relationship-based and communication skills; and improved access to resources. System-level and resource barriers to CC were identified. Knowledge about CC is largely based on descriptions of nurse-led models of PBT care. Further research is required to refine the framework of CC reflecting factors of known importance in PBT care, and identify training and support needs of HCPs who may play a pivotal role in current models of neuro-oncology CC.

Objective:Cancer-related cognitive impairment (CRCI) can impact daily-life functioning of people with aggressive lymphoma. While many studies have examined the neural substrates implicated in CRCI, most have used group-based analyses, which may mask individual differences. In the present study, we used normative analysis to examine longitudinal changes in cognitive functioning and brain morphology at the level of the individual patient. Methods:Nine participants with newly diagnosed aggressive lymphoma underwent neuropsychological assessment and anatomical MR before and 6-8 weeks after chemotherapy. Cognitive test scores were converted to T-scores and classified as impaired if ≤ 30. Deviations in cortical thickness and surface area in the superior frontal gyrus (SFG) and anterior cingulate cortex (ACC) were computed at the level of the individual using the novel CentileBrain tool, with z-scores below - 1.96 and above 1.96 classified as infranormal and supranormal, respectively. Results:Analyses revealed substantial between-subject variability over time and across outcome measures. Cognitive impairments in executive function and verbal memory were identified in three participants before and/or after chemotherapy. CentileBrain results showed seven participants had infranormal cortical thickness and/or surface area in the SFG at one or both time points, and one patient had infranormal values in the ACC. No participants exhibited supranormal values in either region at any time point. Conclusion:Our findings provide a valuable foundation for developing more personalised interventions tailored to the specific cognitive and neural profiles of lymphoma survivors, paving the way for improved clinical care to alleviate and mitigate the impact of CRCI on long-term quality of life. Clinical trial registration:https://www.anzctr.org.au/, identifier ACTRN12619001649101.