Triple I (Innovation-Implementation-Impact)

Novel therapies are driving the emergence of a new population of cancer survivors, those with metastatic or advanced cancers. While rarely cured, many patients are now living several years sometimes decades, with cancers that have spread to distant sites in the body. These patients face a multitude of clinical and supportive care challenges, including high symptom and side-effect burden, financial toxicity, and psychosocial concerns related to living with uncertainty.

Dr Andrea Smith is leading research to improve access to appropriate supportive care for people with metastatic breast cancer, supported by a Professor Martin Tattersall ECR in Supportive Care in Oncology Award and a University of Sydney Bright Ideas Award. Projects include improving access to professionally run metastatic breast cancer support groups, understanding the role and value of metastatic breast care nurses, increasing funding for metastatic survivorship research, and quantifying Australia’s metastatic (or ‘treatable-but-not-curable’) population.

Identifying and enumerating survivors diagnosed with or who have progressed to metastatic cancer in registries and other large databases will lay the foundation for the epidemiologic studies needed to identify and track physical and psychological symptoms, adverse effects, and long-term outcomes related to an advanced or metastatic diagnosis and its treatments. It will also help ensure that our survivorship services are inclusive of and provide appropriate care for this growing population.

With the survival rate of cancer increasing due to improved treatments, there is increasing focus on interventions that can further improve physical, psychological and clinical outcomes in patients during and after treatment. Exercise oncology is a rapidly growing field addressing this gap.

Dr David Mizrahi is leading research investigating exercise oncology in different settings, including research investigating: how exercise can be delivered in childhood cancer hospital and community settings; the effects of exercise on clinical outcomes such as hospital length of stay; and patterns of digital health technology use, so that targeted interventions can be developed and implemented.

David’s overall goal is to promote the implementation of exercise into cancer care, by promoting the field to healthcare professionals, patients and policymakers, to allow for patients to optimise their health outcomes. David is supported by The Kids Cancer Project and seed funding from The University of Sydney.

Incredibly, we can now eliminate (stop) most cervical using a combination of strategies, including cervical screening. However, cervical screening is not equitably implemented. In Australia, multiple barriers (e.g., inaccessible health information), mean that only 1 in every 10 people with intellectual disability have a cervical screening test.

Our team is working with people with intellectual disability and experts in intellectual disability research, to co-deliver ScreenEQUAL, which is a 3-year research project funded by the National Medical Health and Research Council (NHMRC) awarded to the lead Chief Investigator, Prof Deborah Bateson. The project aims to:

1. make it easier for people with intellectual disability to have a cervical screening test, and
2. to have a positive experience with the test.

The project has 2 stages. In stage 1, we are co-designing and co-producing a suite of health information resources and health professional training materials in partnership with people with intellectual disability in the community and healthcare professionals involved in their care. In stage 2, we will conduct a randomised controlled trial of the co-designed information resources and training materials, compared to existing resource on people with intellectual disability:

• Informed decision making to have a cervical screening test, including health literacy.
• Participation in the National Cervical Screening Program during the intervention period

If successful, our team will make the health information resources and training materials freely available in the community.

Lung cancer is the number one cause of cancer deaths worldwide. Lung cancer screening could save thousands of lives through early detection, when treatment is more effective. As implementation of lung cancer screening is imminent in Australia, there is an immediate need for interventions that raise awareness of the benefits and harms of screening in the target population—who typically have lower health literacy levels—and enable rapid translation of shared decision-making into practice.

Dr Rachael Dodd’s research will help guide talking to a doctor to decide about taking part in lung cancer screening. Information will be tailored to different health literacy levels of high-risk people. Rachael’s research will impact on who is engaged and who takes part in a lung cancer screening program. It will also make it more normal and culturally suitable for those groups who will benefit most from screening.

Rachael has received an International Lung Cancer Foundation Young Investigator Award from the International Association for the Study of Lung Cancer to fund this research.

There are more than 1 million Australians living with and beyond cancer. The #1 concern that causes these people to focus on surviving rather than thriving, is fear of cancer recurrence, which is estimated to affect about half of cancer survivors, particularly those from minority backgrounds, leading to greater distress, poorer quality of life, and greater healthcare use.

We actually have effective treatments for fear of recurrence, but they’re not routinely implemented, nor are there established ways of identifying those who need help, and determining what kind of help might be most suitable. Our team of experts on fear of recurrence, health equity and implementation science are developing a world-first standardised, evidence-based and multidisciplinary plan for managing fear of recurrence supported by a Cancer Institute NSW Career Development Fellowship to A/Prof Ben Smith.

After getting feedback to ensure the plan is culturally sensitive, we will pilot its implementation in two ethnically diverse health districts. We will test strategies to ensure the plan is adopted by healthcare professionals, implemented as intended, and maintained over time, ensuring it reaches and effectively addresses fear of recurrence in all cancer survivors, irrespective of their cultural background or language spoken.