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Women with breast cancer often have additional physical and psychological stresses to cope with during their treatment, many of which are preventable. For example, two thirds of those who are hospitalised with advanced metastatic breast cancer will have a delirium episode at some point during a stay in hospital.
Delirium is a serious medical condition affecting the brain, which results in confused thinking and reduced awareness of environment. It also impacts the ability to communicate at a critical time when being mentally aware and interacting with loved ones is crucial for quality of life.
Women with advanced metastatic breast cancer are at higher risk of delirium due to medical problems such as changes in blood levels of calcium or oxygen, infections, and the side effects of their medications. Each year it is estimated that at least 2000 women with advanced breast cancer experienced delirium before their death during a hospital stay. Delirium is reversible in only half of cases and there is no medication to effectively treat its symptoms.
Delirium is one of the most significant medical complications for those in the final stages of breast cancer. It has serious adverse consequences: it is highly distressing to experience for the person themselves and to witness as a family member, it increases the risk of complication in hospital such as falls, reduced independence and function and cognitive capacity, and is associated with longer hospital stays, higher health care costs and a high mortality rate.
The good news is that delirium is preventable in many cases and recent research has shown that incidences of delirium in older hospitalised adults can be reduced by up to 50 per cent. Additional data is needed specifically for the women with advanced metastatic breast cancer which takes into account other factors such as fatigue and/or limited mobility.
NBCF-funded Professor Meera Agar and her team will run a trial to collect data on the benefits of methods to avoid delirium episodes. These methods include ensuring they get enough sleep, enhancing physical function, maximising hydration and nutrition and making sure patients are not isolated from sounds and senses which help to keep them grounded.
Professor Agarâ€™s research program aims to reduce the incidence of delirium in women with advanced metastatic breast cancer by 50 per cent, a change which would mean a significant improvement to their quality and length of life.
Almost 1,500 Australian women are diagnosed with metastatic breast cancer each year, an advanced stage of the disease where the tumour has spread beyond the breast to other organs.
These women face not only a terminal illness, but also deal with poor quality of life and physical health as a result of the disease progressing and the side effects of their cancer treatments.
Although treatments are not yet curative for metastatic breast cancer, they are designed to prolong life so women may endure this stage of the disease in a state of discomfort for many years.
Previous studies in women with early stage of breast cancer have shown that physical activity and a healthy, well-balanced diet are beneficial for these women.
It is also believed that physical activity would help improve the quality of life and wellbeing of women with metastatic breast cancer. However, there have been few studies in this area and there are no guidelines for the best diet and activity that would take into account each womanâ€™s situation and specific needs.
The aim of this pilot study is to determine the viability of an exercise and diet program for women with metastatic breast cancer, and to test whether the program improves womenâ€™s quality of life, wellbeing and physical health.
During the program, participating women will be encouraged to focus on increasing both aerobic-based and resistance-based exercise sessions during personal training sessions tailored to their level of ability and existing fitness.
A dietitian will work closely with women throughout the program to help improve their diet quality. The advice will be tailored to each woman and consider any side-effects they may experience from their treatments, such as nausea/vomiting or constipation/diarrhoea.
This will be the first trial to evaluate an exercise and dietary intervention in this population, and provide much-needed evidence-based knowledge to help improve the quality of life for these women.
Findings from this study will then inform a larger research study and could ultimately inform public health guidelines and support for women with metastatic breast cancer, forming part of their routine cancer care in the future.
Genetic testing has come a long way helping to identify women with a high risk of breast cancer due to family inheritance, particularly the BRCA1 and BRCA2 genes.
However, many of the women who attend familial cancer clinics due to a family history of breast cancer, and have a genetic test, receive results that are not informative. That is, no mistakes in those genes are identified to explain their personal and/or family history of breast cancer.
But that doesnâ€™t mean that these women are not at increased risk of developing breast cancer. This study will investigate how best to provide women with information about their polygenic risk of breast cancer.
For women at familial cancer clinics who received uninformative results from standard genetic testing, polygenic information helps categorise them as low, medium or high risk, opening the door to more personalised risk management strategies.
This could also lead to dramatic changes to current population screening for breast cancer, meaning women without a family history of breast cancer could use polygenic testing to personalise their routine mammographic screening.
Finally, findings from this study could also benefit other diseases, such as cardiovascular disease and diabetes, providing a model for similar research across other important fields in medicine.
This is the worldâ€™s first study to assess the psychological and behavioural impact of offering women information on their polygenic risk of breast cancer. The results will help ensure polygenic risk testing and counselling are included in clinical practice.
When diagnosed with breast cancer women have a lot of things to think about. For younger women, cancer treatment can reduce a womanâ€™s ability to have children in the future. This may add to the worry about the cancer, especially if women have not yet finished their families. Research has shown that some women will make choices based on whether they can have children later. This is why it is very important that women know what the side-effects of cancer treatment are. Since there are steps that women can take to increase their chances of having a child later. To do this, they need to know about their options and they need this information early.
It can be difficult for women to make decisions about which treatment is best for them. If people are not given good-quality information they may regret the choices made. This is why it is important that we give women the information they need to make the best choice for them. This study aims to create and give women in this situation information that is easy to get hold of and to understand. It will test how helpful the information is in helping women to make decisions about what they can do to raise the chances of having a baby at a later date. It is hoped that this will help make these decisions easier. We will also look at how this information can be easily accessed by women as a part of their medical care.
Approximately 70 per cent of women diagnosed with breast cancer have at least one other chronic condition, and one third have three or more.
The presence of chronic conditions (such as diabetes, cardiovascular disease, kidney disease and musculoskeletal disease) impacts treatment choices, increases treatment toxicity, is associated with reduced adherence to treatment and overall survival.
The prevalence of chronic conditions in breast cancer survivors is higher than aged matched cancer-free population, suggesting that either cancer itself or its treatment predisposes patients to chronic conditions. Despite these statistics, the management of chronic conditions is poorly integrated into the care of breast cancer.
The study aims to measure the burden of chronic conditions in breast cancer patients and survivors in Australia and identify populations most at risk of chronic conditions before and after breast cancer.
It will also examine mechanisms behind the development of chronic conditions and consider ways in which they could be prevented.
Professor Bogda Koczwara will develop and pilot strategies for better integrated management of chronic conditions in breast cancer that will lead to improved outcomes (particularly in bone and heart health) and to serve as a model of care for other cancers.
Understanding the origin of chronic conditions in breast cancer and the mechanism for their development may offer insight into prevention of not just chronic conditions but cancer itself.
Breast cancer survivors have poorer health than the general population with an increased risk of cardiovascular disease, diabetes, and osteoporosis, as well as risk of cancer recurrence. They are also at risk of functional decline and poorer health due to treatment-related side-effects, including fatigue and cognitive impairment. Preliminary results suggest these effects may be worse in elderly cancer survivors. I propose a multifaceted approach to study these long-term side-effects and chronic health issues in breast cancer patients with a focus on cognitive function, fatigue, physical activity and weight management. The research includes the following studies:
Breast cancer and its treatment are associated with increased risk of infection, depression, fatigue and learning and memory problems, which often remain long after treatment is discontinued. While little is known about what causes these adverse effects of treatment, their severity can impact quality of life for cancer survivors and can affect the treatment plan for an individual, which directly affects survivorship. Brain inflammation has been linked to neurological deficits, however, its role in the adverse effects of breast cancer chemotherapy has not been investigated. To address this, we will investigate the role of inflammation in the brain in the side-effects of chemotherapy. Additionally, we will explore if infections later in life exacerbate or cause re-emergence of latent side-effects. By understanding how brain inflammation contributes to the debilitating cognitive and mood symptoms of cancer treatment, we can identify novel therapeutic targets to cure the symptoms of chemotherapy. This, in turn, will reduce the need for many patients to alter their treatment plan and improve long-term quality of life in breast cancer survivors.
Most women with invasive breast cancer have hormone sensitive tumours and are treated with an aromatase inhibitor or tamoxifen. Increasingly women are receiving more than five years of this treatment.
Aromatase inhibitors work by blocking the production of estrogen throughout a womanâ€™s body, therefore depriving any remaining breast cancer cells of estrogen. A little talked about side-effect, common among postmenopausal women with hormone sensitive breast cancer taking an aromatase inhibitor is vaginal dryness, irritation, painful sex and urinary tract problems.
These symptoms can be very severe, and lead to avoidance of sexual activity and relationship distress. As a result, some women stop taking their aromatase inhibitor, and this increases the risk of a relapse.
Although low dose vaginal estrogen, which is the standard treatment for these vaginal symptoms, is sometimes used by women in this setting, it would be highly preferable to be able to offer women an effective non-estrogen alternative.
There is some evidence that a low dose of vaginal testosterone cream might be effective and safe for women taking an aromatase inhibitor.
Professor Susan Davis and her team will conduct a trial to evaluate the effectiveness and safety of intra-vaginal testosterone therapy in women taking an aromatase inhibitor and determine their level of sexual satisfaction and function, as well as objective and subjective measures of vaginal health and urinary incontinence.
This study has the potential to improve the wellbeing and quality of life of a large proportion of women who have had breast cancer. This extends beyond individual women to include their intimate partners and contributing to domestic wellbeing.
Professor Davis hopes that information about the study will facilitate discussion about vaginal and urinary tract issues and will de-stigmatise the intimate issues and encourage affected women to seek help and feel more able to discuss their symptoms with their partner.
Women living with advanced breast cancer (also referred to as metastatic cancer, when the tumour has spread) have many points of contact with the health system during their heavy treatment schedule.
Although the general level of cancer care continues to improve, advanced breast cancer patients have indicated that a more tailored system is needed, because they feel their individual physical and emotional needs are not being met, which impacts their quality of life and health outcomes.
For example, having a single contact at their treating centre or hospital, fears about the cancer spreading and having enough information to know how to help themselves are among some of the needs and concerns for women living with advanced stages of breast cancer feel are lacking in current treatment programs.
However, despite growing awareness of these unmet needs, there doesnâ€™t appear to be a move toward developing a tailored supportive care program that these women can access to address their many and changing needs and concerns.
This study sets out to develop and trial a supportive care program that is based on patient input.
It will bring together advanced breast cancer patients, breast cancer oncologists, cancer nurses, allied health professionals, palliative care physicians, breast cancer advocacy and support organisations, cancer researchers and IT expertise to develop a support program that can be accessed either as a face-to-face resource, online or via a smartphone app.
In addition to consumer informed content, the modules will draw together evidence-based resources to inform symptom self-management; healthy lifestyle behaviours; strategies to minimise worry and anxiety; how to recognise and where to get help for depression; practical issues (financial support, superannuation and wills); and issues of relevance for women living with advanced breast cancer, including bone health, menopausal symptoms, diet and exercise.
The program will draw together in one place, for the first time, resources developed specifically for women with advanced breast cancer by key groups such as BCNA, BreaCan and Cancer Council Victoria.
Rural breast cancer patients who undergo surgery to remove breast tumours commonly report practical and financial barriers to accessing face-to-face care in regional and metropolitan centres.
Given increasing access to high speed internet across Australia, online oncology support models have the potential to address the psychosocial, financial and practical burdens experienced by rural breast cancer patients.
By providing web-based pre-operative information to guide expectations for surgical procedures and outcomes, and post-operative follow-up appointments delivered by video-conference, clinicians may be able to reduce rural breast cancer patientsâ€™ anxiety, improve their quality of life, and lead to reduced costs imposed on the patient and health care system.
This project will gather high level evidence about the psychosocial and economic impacts of online oncology support via a randomised controlled trial. The trial aims to compare the outcomes for women on the trial to those receiving usual care in the following areas: 7-day post-operative anxiety; 45-days post-operative health-related quality of life; 45-days post-operative health sector perspective cost-effectiveness.
The aim is to provide reliable information to guide expectations for surgical procedures and outcomes, as well as reduce breast cancer patientsâ€™ anxiety, length of hospital stay, pain and other post-operative complications. Additionally, it will provide information about the effectiveness and cost-effectiveness of an online oncology support model for rural breast cancer patients.