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Baade P.D.,Viertel Center for Research in Cancer Control | Youlden D.R.,Queensland University of Technology | Chambers S.K.,Griffith University
Medical Journal of Australia | Year: 2011

Objective: To report the latest conditional survival estimates for patients with cancer in Queensland, Australia. Design, setting and participants: Descriptive study of state-wide population-based data from the Queensland Cancer Registry on patients aged 15-89 years who were diagnosed with invasive cancer between 1982 and 2007. Main outcome measure: Conditional 5-year relative survival for the 13 most common types of invasive cancer, and all cancers combined. Results: The prognosis for patients with cancer generally improves with each additional year that they survive. A significant excess in mortality compared with the general population ceases to occur within 10 years after diagnosis for survivors of stomach, colorectal, cervical and thyroid cancer and melanoma, with these groups having a conditional 5-year relative survival of at least 95% after 10 years. For the remaining cancers we studied (pancreatic, lung, breast, prostate, kidney, and bladder cancer, non-Hodgkin lymphoma, and leukaemia), conditional 5-year relative survival estimates (at 10 years after diagnosis) ranged from 82% to 94%, suggesting that patients in these cohorts continue to have poorer survival compared with the age-matched general population. Conclusions: Estimates of conditional survival have the potential to provide useful information for cancer clinicians, patients and their carers as they are confronted by personal and surveillance-related decisions. This knowledge may be effective in building realistic hope and helping people manage uncertainty about the future. We suggest that measures of conditional survival be incorporated into routine statistical reporting in Australia.


Baade P.D.,Viertel Center for Research in Cancer Control | Dasgupta P.,Viertel Center for Research in Cancer Control | Aitken J.F.,Viertel Center for Research in Cancer Control | Turrell G.,Queensland University of Technology
Medical Journal of Australia | Year: 2011

Objective: To determine whether an association exists between distance from radiotherapy facilities and survival outcomes of people diagnosed with rectal cancer. Design and setting: Descriptive population-based study using data from the Queensland Cancer Registry. Patients: All patients aged 20-79 years (n = 6848) diagnosed with invasive rectal cancer between 1 January 1996 and 31 December 2006. Main outcome measure: Cause-specific survival. Results: The 5-year cause-specific survival was 62% (95% CI, 61%-64%); it was strongly influenced by stage at diagnosis (American Joint Committee on Cancer, Stages I-IV), ranging from 86% (Stage I) to 9% (Stage IV). After adjusting for age, sex, and stage at diagnosis, patients who lived 100-199 km, 200-399 km and 400 km or more from a radiotherapy facility were 16%, 30%, and 25%, respectively, more likely to die from rectal cancer than patients living within 50 km of such a facility. On average, there was a 6% increase in mortality risk (95% CI, 3%-8%; P < 0.001) for each 100 km increment in distance from the nearest radiotherapy facility. Shared frailty models showed that this association persisted after adjusting for the correlation between individual cancer patients living in the same remoteness or area-level socioeconomic status categories. Conclusions: While centralisation of cancer treatment services has merit, our study provides evidence of a shorter survival for people with rectal cancer who live relatively far from radiotherapy facilities. It remains a priority to develop and implement policy, cultural and clinical measures to reduce the burden faced by rural and remote patients with rectal cancer.


Royle J.A.,University of Western Australia | Baade P.D.,Viertel Center for Research in Cancer Control | Baade P.D.,Queensland University of Technology | Joske D.,Sir Charles Gairdner Hospital | And 2 more authors.
British Journal of Cancer | Year: 2011

Background: Patients with chronic lymphocytic leukaemia (CLL) are known to have increased risks of second cancer. The incidence of second cancers after CLL has not been reported in detail for Australia, a country with particularly high levels of ultraviolet radiation (UVR). Methods: The study cohort comprised of all people diagnosed with a primary CLL between 1983 and 2005 in Australia. Standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) were calculated using Australian population rates. Results: Overall, the risk of any second incident cancer was more than double that of the general population (SIR2.17, 95% confidence interval (CI)=2.07, 2.27) and remained elevated for at least 9 years after CLL. Risks were increased for many cancers, particularly melanoma (SIR7.74, 95% CI=6.85, 8.72). The risk of melanoma increased at younger ages, but was constant across 9 years of follow-up. Chronic lymphocytic leukaemia patients also had an increased risk of death because of melanoma (SMR4.79, 95% CI=3.83, 5.90) and non-melanoma skin cancer (NMSC; SMR17.0, 95% CI=14.4, 19.8), suggesting that these skin cancers may be more aggressive in CLL patients. Conclusion: We speculate that a shared risk factor, such as general immune suppression, modulated by UVR exposure may explain the increased risk of melanoma and NMSC in CLL patients. © 2011 Cancer Research UK All rights reserved.


Morris B.A.,University of Tasmania | Morris B.A.,Viertel Center for Research in Cancer Control | Morris B.A.,Griffith University | Shakespeare-Finch J.,Queensland University of Technology
Psycho-Oncology | Year: 2011

Objective: Theoretical models of post-traumatic growth (PTG) have been derived in the general trauma literature to describe the post-trauma experience that facilitates the perception of positive life changes. To develop a statistical model identifying factors that are associated with PTG, structural equation modelling (SEM) was used in the current study to assess the relationships between perception of diagnosis severity, rumination, social support, distress, and PTG. Method: A statistical model of PTG was tested in a sample of participants diagnosed with a variety of cancers (N=313). Results: An initial principal components analysis of the measure used to assess rumination revealed three components: intrusive rumination, deliberate rumination of benefits, and life purpose rumination. SEM results indicated that the model fit the data well and that 30% of the variance in PTG was explained by the variables. Trauma severity was directly related to distress, but not to PTG. Deliberately ruminating on benefits and social support were directly related to PTG. Life purpose rumination and intrusive rumination were associated with distress. Conclusions: The model showed that in addition to having unique correlating factors, distress was not related to PTG, thereby providing support for the notion that these are discrete constructs in the post-diagnosis experience. The statistical model provides support that post-diagnosis experience is simultaneously shaped by positive and negative life changes and that one or the other outcome may be prevalent or may occur concurrently. As such, an implication for practice is the need for supportive care that is holistic in nature. © 2010 John Wiley & Sons, Ltd.


Baade P.D.,Viertel Center for Research in Cancer Control | Baade P.D.,Queensland University of Technology | Turrell G.,Queensland University of Technology | Aitken J.F.,Viertel Center for Research in Cancer Control | Aitken J.F.,University of Queensland
Journal of Epidemiology and Community Health | Year: 2011

Background: Reducing disparities in cancer outcomes is a major priority for cancer-control agencies. The authors examine the relationships between geographic remoteness, area disadvantage and risk of advanced breast cancer among women. Methods Multilevel models were used to assess the areaand individual-level contributions to the risk of advanced breast cancer among women aged 30-79 years diagnosed as having breast cancer in Queensland, Australia between 1997 and 2006 (n=18 658). Results Women who resided in the most socioeconomically disadvantaged areas were significantly more likely (OR 1.21, 95% CI 1.07 to 1.37) than residents of the most advantaged areas to be diagnosed as having advanced breast cancer after adjustment for individuallevel factors. When geographic remoteness and areadisadvantage (and all the individual-level factors) were simultaneously adjusted, the rates of advanced breast cancer were significantly higher for women residing in Outer Regional areas (OR 1.13, 95% CI 1.02 to 1.24) and those who lived in the most disadvantaged areas (OR 1.16, 95% CI 1.02 to 1.32). There was no statistically significant interaction between geographic remoteness and area disadvantage. Conclusions A woman's risk of being diagnosed as having advanced breast cancer depends on where she lives, separate from the individual characteristics of the woman herself. Both the rurality and socio-economic characteristics of the geographical area in which women lived were important. The socio-economic factors contributing to advanced breast cancer, existing in both urban and rural environments, need to be investigated.


Youlden D.R.,Queensland University of Technology | Baade P.D.,Viertel Center for Research in Cancer Control | Baade P.D.,Queensland University of Technology
BMC Cancer | Year: 2011

Background: Cancer survivors face an increased likelihood of being subsequently diagnosed with another cancer. The aim of this study was to quantify the relative risk of survivors developing a second primary cancer in Queensland, Australia.Methods: Standardised incidence rates stratified by type of first primary cancer, type of second primary cancer, sex, age at first diagnosis, period of first diagnosis and follow-up interval were calculated for residents of Queensland, Australia, who were diagnosed with a first primary invasive cancer between 1982 and 2001 and survived for a minimum of 2 months.Results: A total of 23,580 second invasive primary cancers were observed over 1,370,247 years of follow-up among 204,962 cancer patients. Both males (SIR = 1.22; 95% CI = 1.20-1.24) and females (SIR = 1.36; 95% CI = 1.33-1.39) within the study cohort were found to have a significant excess risk of developing a second cancer relative to the incidence of cancer in the general population. The observed number of second primary cancers was also higher than expected within each age group, across all time periods and during each follow-up interval.Conclusions: The excess risk of developing a second malignancy among cancer survivors can likely be attributed to factors including similar aetiologies, genetics and the effects of treatment, underlining the need for ongoing monitoring of cancer patients to detect subsequent tumours at an early stage. Education campaigns developed specifically for survivors may be required to lessen the prevalence of known cancer risk factors. © 2011 Youlden and Baade; licensee BioMed Central Ltd.


Ownsworth T.,Griffith University | Henderson L.,Griffith University | Chambers S.K.,Griffith University | Chambers S.K.,Viertel Center for Research in Cancer Control
Psycho-Oncology | Year: 2010

Objective: This study investigated the association between functional impairments of individuals with cancer and caregiver psychological well-being, and examined the moderating effect of social support. Methods: Sixty-three caregivers (71% female) of individuals with brain tumor (n=27) and other cancers (n=36) were recruited from community services. Caregivers rated their psychological well-being on the World Health Organisation Quality of Life measure Brief version, social support on a brief version of the Social Support Questionnaire, and the individuals' functional impairments on the Patient Competency Rating Scale. Results: For caregivers of individuals with brain tumor, better psychological well-being was associated with lower functional impairment in all domains (rs=0.33-38, p<0.05), except for cognitive difficulties. For caregivers of individuals with other cancers, better psychological well-being was associated with lower functional impairment in all domains (rs=0.30-0.49, p<0.05), with the exception of activities of daily living. For the total caregiver sample, better psychological well-being was significantly correlated with overall functional impairment (r=0.34, p<0.005) and satisfaction with support (r=0.40, p<0.005). Caregivers supporting individuals with greater functional impairment had better psychological well-being if they were highly satisfied with their social support. Conclusions: Effective social support is particularly important for caregivers who support individuals with poorer functional status, and this study highlights the need to evaluate caregiver social support interventions in the context of cancer. © 2009 John Wiley & Sons, Ltd.


Cramb S.M.,Viertel Center for Research in Cancer Control
Health & place | Year: 2012

This study examines the influence of cancer stage, distance to treatment facilities and area disadvantage on breast and colorectal cancer spatial survival inequalities. We also estimate the number of premature deaths after adjusting for cancer stage to quantify the impact of spatial survival inequalities. Population-based descriptive study of residents aged <90 years in Queensland, Australia diagnosed with primary invasive breast (25,202 females) or colorectal (14,690 males, 11,700 females) cancers during 1996-2007. Bayesian hierarchical models explored relative survival inequalities across 478 regions. Cancer stage and disadvantage explained the spatial inequalities in breast cancer survival, however spatial inequalities in colorectal cancer survival persisted after adjustment. Of the 6,019 colorectal cancer deaths within 5 years of diagnosis, 470 (8%) were associated with spatial inequalities in non-diagnostic factors, i.e. factors beyond cancer stage at diagnosis. For breast cancers, of 2,412 deaths, 170 (7%) were related to spatial inequalities in non-diagnostic factors. Quantifying premature deaths can increase incentive for action to reduce these spatial inequalities. Copyright © 2012 Elsevier Ltd. All rights reserved.


Hawkes A.L.,Viertel Center for Research in Cancer Control
Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2013

Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.


Yu X.Q.,Cancer Research Division | Luo Q.,Cancer Research Division | Smith D.P.,Cancer Research Division | O'Connell D.L.,Cancer Research Division | Baade P.D.,Viertel Center for Research in Cancer Control
Medical Journal of Australia | Year: 2014

Objectives: To determine whether the previously reported urban-rural diff erential in prostate cancer survival remains after adjusting for demographic and clinical factors, and to investigate temporal trends in this diff erential. Design, setting and participants: Retrospective population-based survival analysis of 68 686 men diagnosed with prostate cancer from January 1982 to December 2007 in New South Wales. Main outcome measures: Survival rate and relative excess risk (RER) of death over 10 years of follow-up in relation to geographic remoteness after adjusting for other prognostic factors. Results: Overall, 10-year survival increased during the study period, increasing from 57.5% in 1992-1996 and 75.7% in 1997-2001 to 83.7% in 2002-2007. The increasing trends were also observed across categories of geographic remoteness and socioeconomic status. Urban-rural diff erentials were signifi cant (P < 0.001) after adjusting for fi ve important prognostic factors, with men living outside major cities having higher risk of death from prostate cancer (RER, 1.18 and 1.32 for inner regional and rural areas, respectively). Socioeconomic status was also a signifi cant factor (P < 0.001) for prostate cancer mortality, with the risk of dying being 34% to 40% higher for men living in socioeconomically disadvantaged areas than those living in least disadvantaged areas. There was no evidence that this inequality is reducing over time, particularly for men living in inner regional areas. Conclusions: Despite the increasing awareness of urban-rural diff erentials in cancer outcomes, little progress has been made. Appropriately detailed data, including details of tumour characteristics, treatment and comorbid conditions, to help understand why these inequalities exist are required urgently so interventions and policy changes can be guided by appropriate evidence.

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