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The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.

Objective: Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help‐seeking attitudes than exposure to material focused on rural location only or generic cancer support material. Methods: Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help‐seeking at post‐test (between 1‐2 days). Negative attitudes to help‐seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post‐test was also measured. Results: Analysis (N=114) indicated no detectable group differences (rurality/male gender, n=33; rurality, n=41; control, n=40) on primary or secondary outcome measures (p>.05). Participants’ existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%). Conclusions: Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service. Refereed/Peer-reviewed

Purpose: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. Methods: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA). Results: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. Conclusions: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors’ specific needs and risk factors. Refereed/Peer-reviewed

Purpose of review: To review recent research on cancer-related cognitive impairment (CRCI) in children, including correlational studies and interventions in which outcomes have included cognitive test performance, neuroimaging or academic performance. Recent findings: Impairments in processing speed, working memory, executive function and attention continue to be demonstrated in survivors of childhood cancers. Children receiving radiation treatment for their cancer demonstrate greater impairment than those who undergo surgery and/or chemotherapy without radiation. However, CRCI still occurs in the absence of radiation treatment, particularly in the domain of attention. Recent neuroimaging studies highlight atypical connectivity of white matter and its associations with cognitive performance. Given impairments in cognitive function and associated neuroanatomical factors, it is not surprising that survivors of childhood cancers experience academic difficulties. However, early intervention may provide one means of improving cognitive and academic outcomes. Summary: Children with cancer are at risk of impairment in the domains of processing speed, attention, working memory and executive function. Those who receive radiation are likely to experience greater CRCI than those who do not receive this treatment. All survivors of childhood cancers should be carefully monitored to provide support and implement evidence-based interventions to ameliorate cognitive late effects. Refereed/Peer-reviewed

Rates of referral of patients to psychosocial services are low in most cancer treatment centers, while rates of distress are high. The purpose of this study is to identify clinicians' barriers to referring cancer patients to psychosocial services and strategies that could increase rates of referral. A purposive sampling method ensured data were gathered in two large public teaching hospitals from seven oncologists and five hematologists with varying levels of experience, of whom five were female. Data were collected using semistructured interviews guided by the Capability, Opportunity, Motivation and Behavior model (Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. United Kingdom: Silverback Publishing; 2014.). This helped us to identify modifiable variables associated with referral likelihood and associated evidence-based strategies using the Behavior Change Wheel. Data were analyzed using Thematic Analysis. Barriers relating to capability, opportunity, and motivation to refer to psychosocial services were identified, including lack of knowledge of available services, how to refer to them, and the types of patients who would benefit. Other barriers included the following: lack of time to discuss and refer, convoluted referral pathways, long waiting times, and fear of patient reluctance due to stigma. Respondents identified numerous strategies for overcoming barriers, including training on referral best practice, role-plays, the provision of lists of services with referral and contact details, and increasing service capacity via additional funding. Findings inform the development of acceptable, evidence-based strategies, to improve rates of referral to psychosocial services by oncologists and hematologists. Without implementation, a substantial number of people affected by cancer will continue to suffer from potentially treatable distress. Refereed/Peer-reviewed

Purpose: To improve understanding about; (1) the validity of the Distress Thermometer (DT) as a measure of changes in distress after a cancer helpline call, (2) the impact of a helpline call on callers' distress, (3) caller and helpline nurses’ comfort with use of the DT, and (4) the extent to which DT scores over the critical threshold, are associated with referral to internal support services for follow-up psychosocial care. Methods: Callers (people diagnosed with cancer and their family/friends: N = 100) completed a questionnaire that included DT ratings (three time-points), the Depression Anxiety and Stress Scale-21 (DASS-21) and measures of comfort with the DT tool. Nurses recorded referrals to internal services and their comfort in using the DT in each call. Results: The DT correlated with the DASS-21 depression (r = 0.45, p

Skin cancer is the most commonly diagnosed cancer in many Western countries. This systematic review provides a comprehensive overview of the relationship between skin cancer knowledge and sun-protective, exposure and tanning behaviours in the general population. A total of 34 studies, published in peer-reviewed journals over three decades, were reviewed and synthesised. Sun-protective behaviour was positively associated with skin cancer knowledge in most cases. Findings were inconsistent regarding other sun-related behaviours. Heterogeneity in measurement compromised the capacity to definitively link knowledge and sun-related behaviours. There is a need for development and utilisation of a standardised skin cancer knowledge scale, and guidelines are suggested. Refereed/Peer-reviewed

Objective: The aim of this meta-analysis was to assess whether chemotherapy-related cognitive impairment is consistently observed in cancer patients and to identify the areas of cognition affected. Methods: The meta-analysis included 13 studies and examined the effects of chemotherapy on seven different cognitive domains, across five cancer types. It was the intention of this meta-analysis to stringently exclude many studies, allowing for examination of cognition in carefully selected studies of chemotherapy recipients who do not have current mood or anxiety diagnoses (or psychiatric or substance abuse histories), without brain cancer and who have not had radiotherapy or hormone treatment. A moderator analysis examined whether patient age, treatment duration and time since treatment end significantly contributed to chemotherapy-related cognitive impairment. Results: Evidence for the presence of cognitive impairment following cancer treatment was established for executive function and memory. No relationship was found between cognitive impairment and time since treatment cessation but a significant negative relationship was found for treatment duration. Age had no impact on treatment-related cognitive impairment. Conclusions: Future research must be conducted on chemotherapy-related cognitive impairment in cancer types such as lymphoma and leukaemia, which have received a moderate amount of attention and colorectal cancer, which has received little attention. This would enable us to determine the extent to which chemotherapy-related cognitive impairment is a universal phenomenon associated with the cancer experience and its treatment regardless of cancer type. Refereed/Peer-reviewed