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Study Type - Prognosis (cohort series) Level of Evidence 2b What's known on the subject? and What does the study add? Men diagnosed with prostate cancer are increasingly involved in making their own treatment decisions and the current recommendations for treatment are based on informed choice. The absence of scientific evidence regarding optimum treatment choices underlines the importance of understanding which factors influence the selection of treatment by men diagnosed with prostate cancer. Previous studies have found that men diagnosed with prostate cancer were more likely to choose radiation therapy over radical prostatectomy if they were older and had a higher PSA level. This is the first large-scale prospective study conducted outside the USA to quantify the factors associated with treatment decisions for men diagnosed with prostate cancer. It found that men who chose surgery were younger, above average physical health, and had lower grade cancers on the Gleason scale; men who had radiation therapy were older and had reduced physical health, with ADT added when men had more advanced disease. About two-thirds of the men said they primarily made the decision about treatment themselves, with the remaining men either sharing the decision-making process with their doctor or else leaving the decision more or less completely up to their doctor. These results highlight the importance of having quality up-to-date information readily available to guide these decisions. OBJECTIVE To examine demographic, clinical and quality-of-life indicators for the treatments received by men diagnosed with prostate cancer in Australia., SUBJECTS AND METHODS This prospective trial included men diagnosed with prostate cancer ( n= 1064, response rate = 82%) between 2005 and 2007 in Queensland, Australia, sampled from urologists and hospital outpatient clinics., Data were collected through telephone interviews and self-administered questionnaires., Treatment received was categorized into five groups: radical prostatectomy; radiation therapy with neoadjuvant androgen deprivation therapy (ADT); radiation therapy alone; ADT alone; and monitoring., RESULTS Sharp contrasts in the choice between radical prostatectomy (47% of men) vs radiation therapy with ADT (30%) were evident among age at diagnosis, travel time to facilities offering radiation treatment, Gleason score, stage, body mass index and physical health., Men who underwent surgery were younger and of above average physical health, and had lower grade cancers; men who underwent radiation therapy were older and less fit. ADT, in both neoadjuvant and definitive forms, was administered for high-risk and more advanced disease., Two-thirds (66%) of men stated that they made the final treatment selection themselves., CONCLUSIONS These results suggest that men's baseline health and tumour characteristics influence treatment choices., Distance from tertiary treatment centres also influenced the treatment received and access to specialist urologists may play a role., With most men indicating high levels of decisional control, the importance of having quality up-to-date information readily available to guide their decisions cannot be overstated. [ABSTRACT FROM AUTHOR]

Purpose: Benefit finding after cancer is common. The mechanism for this may include cognitive processing of the cancer trauma within a supportive social context. Methods: Cross-sectional survey of 439 cancer patients assessing optimism, intrusion, avoidance, social support and constraints, anxiety, depression, QOL, benefit finding. Results: Benefit finding was predicted by female gender, greater optimism, high intrusive thinking, high social support and constraints. Conclusions: The role of social constraints in the generation of benefit finding is unclear. Future research should assess how the specific nature of intrusive thoughts may influence benefit finding over time and how social environment interacts with this. [ABSTRACT FROM PUBLISHER]

Background: Patterns of diagnosis and management for men diagnosed with prostate cancer in Queensland, Australia, have not yet been systematically documented and so assumptions of equity are untested. This longitudinal study investigates the association between prostate cancer diagnostic and treatment outcomes and key area-level characteristics and individual-level demographic, clinical and psychosocial factors. Methods/Design: A total of 1064 men diagnosed with prostate cancer between February 2005 and July 2007 were recruited through hospital-based urology outpatient clinics and private practices in the centres of Brisbane, Townsville and Mackay (82% of those referred). Additional clinical and diagnostic information for all 6609 men diagnosed with prostate cancer in Queensland during the study period was obtained via the population-based Queensland Cancer Registry. Respondent data are collected using telephone and self-administered questionnaires at pre-treatment and at 2 months, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months post-treatment. Assessments include demographics, medical history, patterns of care, disease and treatment characteristics together with outcomes associated with prostate cancer, as well as information about quality of life and psychological adjustment. Complementary detailed treatment information is abstracted from participants' medical records held in hospitals and private treatment facilities and collated with health service utilisation data obtained from Medicare Australia. Information about the characteristics of geographical areas is being obtained from data custodians such as the Australian Bureau of Statistics. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residences to treatment centres. Analyses will be conducted using standard statistical methods along with multilevel regression models including individual and area-level components. Conclusions: Information about the diagnostic and treatment patterns of men diagnosed with prostate cancer is crucial for rational planning and development of health delivery and supportive care services to ensure equitable access to health services, regardless of geographical location and individual characteristics. This study is a secondary outcome of the randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12607000233426) [ABSTRACT FROM AUTHOR]

This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June–July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed. • Food insecurity and its determinants impact remote Indigenous communities. • Remote Indigenous people cope with food insecurity and it is accepted as 'normal'. • Indigenous cultural practices such as sharing food buffer food insecurity. • Food security policies should reflect remote Aboriginal suggestions and experiences. [ABSTRACT FROM AUTHOR]

Objective: To examine the relation between socio-demographic and clinical factors, and time from consultation to diagnosis and treatment for men with prostate cancer., Methods: Men diagnosed with prostate cancer (n = 1,064, response rate = 82%) were recruited through participating urologists and hospital outpatient clinics in Queensland, Australia, and completed telephone interviews and self-administered questionnaires. Outcome measures were the diagnostic interval (initial consultation to definitive diagnosis) and treatment interval (definitive diagnosis to start of treatment)., Results: Median time to diagnosis was 73 days (IQR = 41-144) and median treatment interval was 65 days (IQR = 36-107). After adjustment, men were more likely to wait more than 70 days for their definitive diagnosis when they initially presented with symptoms (compared with a general checkup) or did not have private health insurance. For treatment interval, men without private health insurance or who were treated with radiotherapy alone were more likely to wait more than 70 days. Treatment intervals were shorter when men received androgen deprivation therapy combined with radiotherapy., Conclusions: Differences in waiting times for diagnosis and treatment related to access to private hospital care suggest that there are inequities in health-care service provision that are system based.

Background: Patterns of diagnosis and management for men diagnosed with prostate cancer in Queensland, Australia, have not yet been systematically documented and so assumptions of equity are untested. This longitudinal study investigates the association between prostate cancer diagnostic and treatment outcomes and key area-level characteristics and individual-level demographic, clinical and psychosocial factors., Methods/design: A total of 1064 men diagnosed with prostate cancer between February 2005 and July 2007 were recruited through hospital-based urology outpatient clinics and private practices in the centres of Brisbane, Townsville and Mackay (82% of those referred). Additional clinical and diagnostic information for all 6609 men diagnosed with prostate cancer in Queensland during the study period was obtained via the population-based Queensland Cancer Registry.Respondent data are collected using telephone and self-administered questionnaires at pre-treatment and at 2 months, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months post-treatment. Assessments include demographics, medical history, patterns of care, disease and treatment characteristics together with outcomes associated with prostate cancer, as well as information about quality of life and psychological adjustment. Complementary detailed treatment information is abstracted from participants' medical records held in hospitals and private treatment facilities and collated with health service utilisation data obtained from Medicare Australia. Information about the characteristics of geographical areas is being obtained from data custodians such as the Australian Bureau of Statistics. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residences to treatment centres. Analyses will be conducted using standard statistical methods along with multilevel regression models including individual and area-level components., Conclusions: Information about the diagnostic and treatment patterns of men diagnosed with prostate cancer is crucial for rational planning and development of health delivery and supportive care services to ensure equitable access to health services, regardless of geographical location and individual characteristics.This study is a secondary outcome of the randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12607000233426).