Victoria White

Background: Participation in breast cancer screening among culturally diverse women in Australia remains below national targets. Healthcare providers, particularly general practitioners (GPs), play a pivotal role in bridging communication and knowledge gaps and in advocacy, especially for under‐screened South Asian (Pakistani and Indian) women. Objective: To explore communication and health education strategies used by healthcare providers to encourage breast cancer screening among culturally diverse South Asian women living in Victoria. Methods: A qualitative study involving semi‐structured interviews with 15 GPs and non‐primary healthcare providers in Victoria, Australia. Participants were recruited using purposive and snowball sampling methods, drawing from primary care, specialist networks and peer‐to‐peer referrals. Reflexive thematic analysis was applied to identify communication strategies and system‐level insights. Results: Three major themes were identified: (1) encouraging health engagement; (2) communication strategies; (3) cultural sensitivity of healthcare providers. Trust‐building strategies were important in encouraging health engagement and reducing resistance to screening and misconceptions. Participants reported low levels of health literacy, including limited awareness of BreastScreen Victoria's free service. While interpreters aided communication, they also posed challenges in maintaining efficient consultations. Healthcare providers promoted patient‐centred, visual resources to support screening discussions. Cultural sensitivity was emphasised through the use of culturally competent tools and healthcare providers' ongoing cultural training. Existing screening informational resources were considered insufficient to address the cultural preferences of screening South Asian women. Conclusions: Strengthening breast cancer screening for culturally diverse women relies on building trust through culturally competent healthcare providers who can support their patients' engagement with screening through empowering communication, tailored tools and shared decision‐making. So What: Healthcare providers are key enablers of breast cancer screening participation among South Asian women. Investing in culturally competent communication, tailored resources and workforce training could substantially improve screening engagement among South Asian women who remain under‐screened despite access to free screening services.

Background: Informal carers are essential in supporting people with cancer yet often experience unmet supportive care needs. Aims: The aim of this study was to examine (a) access to supportive care services (b) perceived barriers to accessing services, and (c) the potential influence of carer health literacy on access and barriers to supportive care among carers across three priority population groups (rural‐remote‐dwelling, LGBTIQA+ and culturally and linguistically diverse (CALD)). Methods: Cross‐sectional online survey of Australian adult cancer carers. Supportive care use, access barriers, and health literacy (Health Literacy of Caregivers Scale – Cancer (HLSC‐C)) were assessed. Logistic regression examined differences across priority groups, and mediation analyses explored the role of health literacy. Results: Among 1154 carers, 61.9% accessed some supportive care (46.7% formal services), yet 86.6% reported at least one barrier, with 71.0% reporting two or more. Common barriers were time constraints, service availability, and long wait times. Compared to non‐priority population carers, rural/remote carers had higher odds of reporting limited local availability and services not available when needed (aOR = 5.08 for both). CALD carers had higher odds of reporting a barrier (aOR = 1.81), including long wait times, cost, and lack of culturally appropriate services (aOR = 33.03). Health literacy significantly mediated the association between CALD status and reported barriers. Conclusions: Cancer carers have limited access to supportive care and face systemic barriers. Inequities remain, particularly for carers from rural/remote areas and those from CALD backgrounds. To improve equity, there is a need for co‐designed, accessible interventions that address health literacy and the diverse geographic, cultural, and linguistic needs of carers. Patient or Public Contribution: People with lived experience of cancer caregiving were included on this study's advisory committee. In this role, their expertise informed the study design, including the development of the questionnaire, the Participant Information and Consent Form (PICF), and recruitment processes. They were also invited to contribute to data interpretation and the preparation of this manuscript. The lead consumer representative (NR) is listed as a co‐author on this manuscript.

Issue Addressed: To explore Australian adolescents' perceptions of the risks and health harms associated with vaping and their attitudes towards e‐cigarettes and examine if these vary by demographic and other factors. Methods: Data were from a 2022‐2023 cross‐sectional, school‐based survey of Victorian students aged 12–17 years ( n = 1701 [weighted]; n = 1696 [unweighted]). Separate multivariable logistic regression models tested associations between agreement with each perception/attitude and predictors (age group, gender, area‐based socio‐economic status, vaping susceptibility, e‐cigarette marketing exposure, peer vaping), controlling for education sector and school‐level clustering. Results: Most students (≥ 86%) agreed that vaping is harmful and addictive and that e‐cigarettes contain harmful substances and nicotine, while agreement that breathing other people's e‐cigarette vapour can affect your health was somewhat lower (69%). Perceptions of vaping harms tended to be stronger among females (vs. males) and weaker among past‐month vapers (vs. non‐susceptible, never‐vapers). Overall, students held more negative than favourable attitudes towards e‐cigarettes. However, vaping susceptibility, being of younger age and having a close friend that vapes were independently associated with having more favourable attitudes towards e‐cigarettes (e.g., they look cool, make vaping look exciting). Further, past‐month exposure to e‐cigarette advertising was associated with students believing that e‐cigarettes look good, make vaping look appealing, encourage them to vape and encourage them to buy an e‐cigarette. Conclusions: Findings provide support for recent government policies to limit e‐cigarette advertising and retail access, and the delivery of youth‐targeted educational campaigns about vaping. So What?: Ongoing monitoring is important to assess sustained change over time in e‐cigarette knowledge and attitudes among Australian adolescents, with this study providing an important pre‐reform baseline against which such changes can be evaluated.

Background: The treatment landscape for chronic lymphocytic leukaemia (CLL) has transformed over the past decade. This study aimed to estimate the healthcare costs and health burden associated with CLL in Australia. Methods: A Markov model was developed to simulate the lifetime healthcare costs and health outcomes associated with CLL in Australia under the CIT‐only era and the current era incorporating targeted therapies. The model considered treatment initiation, switching, and long‐term survival. Clinical inputs were derived from Australian Cancer Database data (2009–2020) for the CIT era, while cost and utility parameters were obtained from government sources and published literature. The model ran over a 15‐year horizon, reflecting the average age of CLL onset in Australia (68 years). Deterministic and probabilistic sensitivity analyses were performed. Results: Total healthcare costs were substantially higher in the targeted therapy era ($751 727 per patient) compared to the CIT era ($33 505 per patient). Drug costs, particularly continuous BTKis therapy, were the main driver ($739 960 vs. $15 359). CLL patients were estimated to accumulate 3.62 and 7.83 QALYs in the CIT and targeted therapy eras, respectively, compared to 10.56 QALYs for the general population aged 68—indicating QALY losses of 6.94 and 2.73, respectively. Life expectancy shortfalls were 6.69 and 3.21 years, respectively. Targeted therapy led to incremental gains of 4.22 QALYs and 3.47 life years. Sensitivity analysis identified that discount rate, age at onset, treatment costs, and time horizon significantly influenced incremental costs, while treatment effectiveness and quality of life in the progression‐free state were key drivers of QALY gains. Conclusions: CLL imposes a significant economic burden and QALY loss. While targeted therapies offer meaningful health gains, their high cost highlights the need for strategic planning to ensure sustainable resource allocation. Policymakers should balance clinical benefit with financial impact to optimise value in cancer care.

Background Androgen deprivation therapy (ADT) improves survival in advanced prostate cancer but may lead to debilitating side effects, including sarcopenic obesity and a 10–45% increased risk of other comorbidities. Guidelines recommend exercise and nutrition interventions during ADT, but access to these services is often limited, and referral pathways are unclear. This study aims to evaluate the feasibility and preliminary efficacy of an online, home-based, multi-faceted, exercise, nutrition and education programme (ProHealth) for men with prostate cancer treated with ADT. ProHealth was co-designed with consumers and healthcare professionals to include (i) education on prostate cancer and treatment-related side effects and (ii) multimedia behaviour change resources to support individualised nutrition and exercise behaviour change. Methods and analysis This 12-week randomised controlled trial (target n=50) will include men treated with ADT for >3 months or who have completed ADT in the last 24 months, are overweight or obese and are not under the care of a dietitian or exercise professional. Participants will be randomised (1:1) to the ProHealth intervention or usual care. The intervention group will receive four consultations with an Accredited Practising Dietitian to promote a high protein and energy reduced diet, and five consultations with an Accredited Exercise Physiologist to follow a home-based progressive resistance training and aerobic exercise programme. The primary outcomes are feasibility (recruitment rate, retention, data completeness, reach, safety, consultation attendance and adherence, and usage of the ProHealth web platform), acceptability and satisfaction of the ProHealth intervention. Exploratory secondary outcomes will be assessed at baseline and 12 weeks and include changes in body weight and composition (total and appendicular fat-free mass, fat mass), quality of life (Functional Assessment of Cancer Therapy (FACT)—General, FACT-Prostate, FACT-Fatigue), physical function (30-second sit-to-stand), dietary intake (3-day food diary) and physical activity (7-day accelerometer). Linear regression models will estimate differences between the intervention and usual care group. Qualitative interviews on participant satisfaction will be transcribed verbatim for thematic analysis. Ethics and dissemination This study is approved by Deakin University Human Research Ethics Committee (DUHREC2024-038) and registered on Australian and New Zealand Clinical Trials Registry (ACTRN12624000874516). Findings will be disseminated through peer-reviewed journals, scientific meetings and other public forums. Trial registration number ACTRN12624000874516.

Background: Autologous stem cell transplant (AuSCT) improves survival in haematological cancers, yet often involves a lengthy recovery associated with a myriad of psychological and physical challenges. Psychological prehabilitation is recommended to improve functional outcomes by addressing psychological concerns and promoting optimal mental and physical health prior to AuSCT. Despite this, little is known about the implementation and experiences of psychology‐specific prehabilitation for AuSCT. Aims: The current study explores the perspectives and experiences of AuSCT recipients and healthcare professionals (HCPs), regarding optimal psychological prehabilitation. Methods: Qualitative interviews were conducted with AuSCT recipients and HCPs experienced in working with AuSCT recipients. AuSCT recipients were recruited at a regional Victorian public health service offering psychological prehabilitation. Purposive sampling was used for HCPs, ensuring a range of professions participated. Reflexive thematic analysis was conducted on interview data, with triangulation utilised to identify themes. Results: Nine AuSCT recipients and 12 HCPs participated. All themes were shared across AuSCT recipients and HCPs. Four themes (each with subthemes) were identified: Fostering Psychological Preparedness for Transplant (Exploring Expectations, Addressing Psychological Concerns), Getting Through the Long Haul (Prioritising Social Support, Planning Emotional and Practical Care), Strengthening Engagement with Psychology (Destigmatising Psychology, Psychology Enhances Overall Prehabilitation) and Looking Toward Sustainability (Individualised Stepped‐Care, Screening and Risks) . Conclusions: Psychological prehabilitation is considered crucial for optimal preparation and recovery from AuSCT, however stigma and limited psychology resources can impact access. Future research should investigate sustainable models of psychological prehabilitation, such as stepped care, to adequately meet the needs of this growing population.

Background: Unpaid caregiving is a critical but often under‐recognised component of the cancer care continuum. As cancer prevalence rises globally, particularly in lower‐income countries, quantifying the time and economic burden of unpaid caregiving across regions is essential for health resource planning, economic participation and support services. This systematic review aimed to quantify the global burden of unpaid cancer caring by examining care hours and associated costs, disaggregated by country income level based on the Socio‐Demographic Index (SDI). Methods: We systematically searched databases for studies published up to January 2026 that reported unpaid cancer caregiving hours and/or costs. Data were extracted and synthesised narratively, and where appropriate, pooled using random‐effects meta‐analysis for unpaid care hours. Study quality was assessed using standard checklists appropriate to the study design. Results: Twenty‐six studies met the inclusion criteria, with the majority conducted in high‐income countries. Unpaid care hours ranged from 1.3 to 113.8 h per week, with a pooled estimate of 48.35 h (95% CI: 17.81–78.89), though heterogeneity was high ( I ² = 100%). Unpaid care costs varied widely, with monthly costs averaging US$2249 (range: US$346–US$5626) in high‐SDI countries; US$196 in high‐middle SDI countries; US$26 in middle SDI countries; US$24 in low‐middle SDI countries; and US$37 in low‐SDI countries. Costing methods varied, with opportunity cost and replacement cost approaches most commonly used. Conclusions: Unpaid carers dedicate substantial time to support people living with and beyond cancer, offering essential assistance that fills critical gaps in health services. This contribution represents a substantial economic burden that remains largely uncompensated. There is a striking lack of data from low‐ and middle‐income countries, where the incidence of cancer is rising, and unpaid care resources are limited. Future research must prioritise recognition, valuation and support for unpaid carers, thus helping increase economic productivity, particularly in underserved settings.

Background: Advances in clinical cancer care have increased the number of survivors, which has impacted informal caregiving. This study estimates the annual opportunity cost of informal cancer care and quantifies the gap in the quality adjusted life expectancy (QALE).Method: Informal cancer carers by sex and two age groups (15–64 years old and 65 years old and over) from the Australian Bureau of Statistics (ABS), Survey of Disability, Ageing and Carers (SDAC) from 2003 to 2022 were used to estimate the annual opportunity costs of informal cancer care in 2022 and predict future costs. Costs were based on an hourly wage rate, and the QALE were calculated by combining health‐related quality of life (HRQOL) with life expectancy.Results: In 2022, there were 59,100 informal cancer carers (61% female, 61% were above 65 years). The average time for informal cancer care was 28.6 hours per week. The average informal care cost was $60,853 per carer, and the cost is estimated to rise by 11% in 2025 and 30% in 2028. The QALE loss ranges from 1.8 to 5.4 months per year of caring, depending on age group and sex.Conclusion: The time spent caring for people living with cancer by informal carers is significant. Recognizing and rigorously investigating the role of informal cancer carers in reducing the burden on the formal care sector and improving the quality of life of people living with cancer is essential to understanding the impact and significance of caring, which will facilitate impactful policy changes.