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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 woman’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 doesn’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 patients’ 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 patients’ 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.