2020 Annual Review

“We are so grateful to be honoured for our efforts to address NCDs using law, and proud to share the honour with our fantastic partners and alumni,” Hayley Jones, Acting Director of the McCabe Centre said.

The McCabe Centre is the only centre of its kind in the world advancing law to fight cancer and other NCDs and promote equitable access to safe, effective and affordable care for people affected by them. Its work includes world-leading research and a capacity building program which since 2014 has trained more than 200 lawyers and policymakers from 70 countries on effective use of law to address cancer and other NCDs.

To date, alumni of the McCabe Centre training have gone onto support the passing of laws and/or regulations contributing to NCD prevention and control in 19 countries. Alumni in six countries have also successfully defended public health laws from legal challenges by the tobacco industry.

“Action to prevent and control NCDs has become more important than ever because of the COVID-19 pandemic, and we remain committed to working across sectors to respond to health issues and create sustainable change,” Jones said.

The McCabe Centre is a joint initiative of Cancer Council Victoria, the Union for International Cancer Control (UICC), and Cancer Council Australia, with staff based in Australia, the Philippines, Fiji and Kenya.

The World Health Organization recently identified a critical need for tools to monitor children’s exposure to and engagement with unhealthy advertising.

Lead researcher, Associate Professor Kathryn Backholer of Deakin University, said with the rise of digital and social media platforms, children are being exposed to high volumes of personalised and targeted marketing of alcohol, tobacco and junk food.

The tool will use cutting-edge AI technologies and eye tracking capabilities, which have been developed for use by Australian Defence and elite sports behavioural psychology.

Understanding how children engage with various forms of advertising and marketing strategies will support future policies to effectively protect children and the wider public health.

Protecting children from harmful exposure to unhealthy marketing is crucial to the prevention of cancer and a priority for Cancer Council Victoria.

A recent study by our behavioural scientists found that when unhealthy food and drink brands sponsor kids’ sport programs, parents are more likely to recognise, choose and view these brands in a positive light.

The study, published in Public Health Nutrition, tested over 1,300 Australian parents’ responses to simulated sponsorship of children’s sport by unhealthy food and drink brands. They compared it to two pro-health sponsorship options - healthier food branding and healthy eating campaign branding.

The study found that parents exposed to unhealthy food and drink sponsorship in kids’ sport were more than twice as likely to be aware of these brands than parents exposed to non-food brands. They were also almost twice as likely to choose unhealthy products when asked to choose a preferred food brand.

The research also found that they held more positive attitudes towards these unhealthy brands, viewing them as more aligned with the healthy, active image of kids’ sport.

Cancer Council Victoria’s Principal Research Fellow and lead researcher of the study, Associate Professor Helen Dixon said the research proved just how powerful sports sponsorship is in boosting the image and appeal of unhealthy food and drink sponsors’ brands.

In 2007, just over 50% of the Victorian population had never smoked (53.5%) while in 2019, almost two-thirds of the population (63.8%) had never smoked.

The decline is driven by a large increase in the numbers of female never-smokers and 200,000 ex-smokers.

These successes are the result of Australia’s long-term commitment to comprehensive, evidence- based tobacco control measures, with the Cancer Council playing a leading role in the research, development and/or implementation of many of the measures.

The measures include bans on tobacco advertising, the introduction of plain packaging and enlarged graphic health warnings for tobacco products, smokefree public places, increases in taxes on tobacco products, innovation of Quitline counselling to support cessation, and public awareness campaigns that deter initiation of smoking and motivate people who smoke to attempt to quit.

Evidence shows us how often and how many advertisements are required to motivate people who smoke to seek advice and information to quit. There is a direct correlation between campaign levels on television and calls to the Quitline from people wanting to stop smoking.

The smoking prevalence could have been driven down further if public education campaigns had reached evidence-based levels over the past five to six years.

The number of Victorians who continue to smoke on an occasional basis is still a concern – while the prevalence of smoking within the population continues to fall, population growth means there is still a high number of Victorians who smoke.

There has also been an increase in the proportion of Victorian smokers who are using e-cigarettes, with pronounced usage among teenagers.

The impact of this number of potentially missed diagnoses is unknown, but any delay in cancer diagnosis for Victorians could mean their cancer is detected at a later stage, meaning potentially fewer treatment options and worse outcomes.

The most significant decrease in pathology notifications, and therefore likely missed diagnoses, occurred for head and neck, prostate and breast cancer and melanoma, in older Victorians, in men, and in people living in higher socio-economic areas.

Melanoma reporting to the Victorian Cancer Registry decreased by 31 per cent in the first period of restrictions in Victoria (30 March to 30 June 2020) compared to the pre-COVID period (1 Feb to 27 March 2020).

During 2020 there was increasing concern amongst health professionals that people with signs of cancer, and other health conditions, may not be contacting their doctors to discuss new symptoms.

The concerns prompted Cancer Council Victoria to develop its “Don’t Delay” campaign, urging people not to delay follow up appointments, to speak to their doctor if they had any health concerns and to continue cancer screening for breast, bowel and cervical cancer.

The campaign ran on TV, radio and online.

Cancer Council will continue to encourage Victorians to prioritise their health and work to increase participation in screening, one of the most effective ways to detect the early signs of cancer and increase survival.

Cervical cancer is largely preventable thanks to both HPV vaccination and cervical screening, yet sadly 218 Victorian women were diagnosed with the disease in 2019.

While the National Cervical Screening Program, which began in 1991, has seen much success, a renewed screening program was introduced in December 2017. Data indicates that this renewed program is working, with a significant increase in pre-cancers detected with the current, more effective test.

The good news is also a result of the National HPV Vaccination Program. The report shows a significant decline in pre-cancer and invasive cervical cancer in young women, indicating the effectiveness of HPV vaccine.

But while we could be the first jurisdiction in Australia to eliminate cervical cancer, we need to focus on the inequities that exist in our society and prioritise communities that have lower screening and immunisation rates.

The introduction of self-collected HPV tests could increase screening rates for never-screened and under-screened women aged over 30. This method could be a significant tool to fast-track the equitable elimination of cervical cancer. Women should talk with their doctor or nurse cervical screening provider to see if they are eligible for self-collection. The test is easy to do and effective at detecting HPV.

She had always participated regularly in cervical screening. Throughout her 30s, she had received a few abnormal Pap test results, which meant she was extra vigilant to prioritise screening.

Unfortunately, in the midst of organising her life to move back to Australia after a stint in the UK, she was diagnosed with a squamous cell cervical cancer tumour at the age of 39.

Link to https://www.cancervic.org.au/about/stories/karina-cervical-cancer.html

Of the common cancers, for both men and women, rates are significantly higher for liver, lung, brain, bowel and head and neck. 

Aboriginal women record higher rates of cervical cancer than non-Aboriginal women, along with pancreas, breast, uterus and vulva cancer. 

Evidence shows that when the Aboriginal community determines and leads the implementation of  strategies, then success can be achieved and sustained. Examples of this include the development and delivery of an Aboriginal comedy around bowel screening, Quit smoking animations and cancer screening resources. 

Altogether, the nurses responded to 9,402 requests for information and support via calls and emails.

Thanks to donations from the Victorian community, our support services were there for everyone affected by cancer when they needed it most to provide emotional and practical support, as well as information about cancer treatments and how to navigate the health system during this challenging time.

Nurses reported a higher level of concern, with 80% of connections describing their distress as moderate (30%) to severe (50%), with levels peaking in April and June, coinciding with lockdown announcements.

Like Susan, who was pregnant with her fifth child when she was diagnosed with cancer. While she was undergoing chemotherapy, COVID-19 broke out.

Already taking care of four kids under six years old with another on the way, Susan said the additional challenges of COVID-19 had a significant impact on her cancer experience.

At the time Susan said: “It feels like cancer has to take a back seat; we have to deal with coronavirus. It’s lonely. All of a sudden it feels like all this support has just been pulled away from you.”

Finding it hard to find the support she needed during lockdown, Susan called 13 11 20 where she was linked to the services and support she needed.

Our cancer nurses were able to support patients like Susan, by helping them navigate the health system and restrictions, as well as linking them to essential services that could make a challenging time a little easier, and less lonely.

Nearly 500 people were supported by our pro bono financial and legal service in 2020, while our wig service was the only one operating. We adapted the service to be fully postal, with 291 people having a free wig mailed to them. 

“It all happened so quickly. My head just spun. When you hear a diagnosis like that it’s true what they say. Your whole life flashes before your eyes in an instant.”

Within two weeks, Vicki was in hospital getting ready for life-saving surgery.

There’s no good time to get cancer, but the timing of Vicki’s diagnosis could barely have been worse. She’d only just moved into a new job in aged care.

Link to rest of story here: https://www.cancervic.org.au/about/stories/vickis-financial-distress.html

In March, not only did she have to endure the shock of a Hodgkin’s Lymphoma diagnosis, she had to complete treatment through all the uncertainty and disruption of COVID-19.

“No one could come in [to the hospital] with me – I think mum came to my first treatment and from there I was on my own,” said Marnie.

“It’s pretty scary because you’re going into hospital not knowing what’s really going on and all by yourself, but I guess that’s how it had to be.”

Link to: https://www.cancervic.org.au/about/stories/marnies-story.html

A/Prof Siva will use the five-year fellowship to investigate the use of a high precision technique called stereotactic ablative body radiotherapy (SABR) to ‘kickstart’ patients’ immune response, maximising the effects of immunotherapy.

A/Prof Siva’s research will include clinical trials investigating outcomes in patients with lung, kidney, prostate and breast cancers.

A/Prof Siva said the fellowship is critical for him to complete key studies and help pinpoint key factors in successful combination therapy.

“Immunotherapy is a major advance in cancer therapy, with the potential to improve outcomes in a range of different cancers. However, methods to improve the effectiveness of immunotherapy are urgently needed. This is where radiotherapy fits in.”

“I hope my research will significantly benefit cancer patients by providing them with access to effective, precision SABR + immunotherapy treatment, as well as identifying patients who are most likely to respond to this treatment.”

The fellowship was named in memory of Dr John Colebatch to mark his contribution to the Cancer Council and his work in the field of paediatrics. Dr Colebatch pioneered the use of chemotherapy in Australia in the 1950s to treat and, ultimately, cure childhood leukaemia.

Thirty years and more than 900 scientific papers later, things have come a long way.

Some of the biggest breakthroughs of the Health 2020 study relate to body composition, diet and alcohol consumption.

“Health 2020 has been used to investigate associations between diet and a wide range of health outcomes,” Professor Roger Milne, Head of the Cancer Epidemiology Division at Cancer Council Victoria and Chief Investigator of the MCCS, said.

“The influence of dietary patterns has been investigated in relation to lung, bladder and breast cancer, type 2 diabetes, healthy ageing and more.”

By providing the evidence required to increase awareness of the health-related benefits and risks associated with dietary factors like alcohol, sugar, vegetables and fatty acids, Health 2020 is helping people make better choices to lower their risk of cancer.

In addition to these discoveries, Health 2020 made significant advances in understanding another factor: genetics.

“What we did not anticipate was the rapid growth in genomic technology and knowledge,” said Professor Graham Giles, the study’s Founding Investigator.

“Health 2020 blood samples became a highly valuable source of DNA to examine genetic risk factors for disease. This field of research has been our principal focus for the past 15 years.”

This led to the identification of hundreds of common genetic variants associated with the risk of more common cancers such as breast, bowel and prostate cancer, and to the discovery of many novel genetic variants linked to rarer cancers, like ovary and pancreas cancer.

Health 2020 is continuing to make such discoveries and have a global impact to this day.

The project, Identifying new treatment options for the rare and aggressive ovarian carcinosarcoma, is using a “unique toolbox” of pre-clinical models and screening technology which will allow new treatments to be tested.

While there is currently a range of treatments available for some ovarian cancers, fewer exist for ovarian carcinosarcoma (OCS). The rare incidence and lack of symptoms mean patients are often diagnosed at a late stage with treatments more suited for other types of ovarian cancers.

“Ovarian carcinosarcoma desperately needs better evidence-based treatment options. Through this project, we hope to challenge and refine the current treatment strategy for this rare, aggressive cancer. From this study, we can learn valuable lessons to benefit many rare cancer patients,” Dr Barker said.

OCRF CEO Lucinda Nolan said, “These types of partnerships allow the OCRF to bring funding into an area of ovarian cancer research that we might not otherwise be able to consider or fund.  We hope this is another step-change in improving the treatment and outcomes for women with ovarian cancer.”

Research funding has been hit hard by the pandemic, so the generosity of the Victorian community ensures Cancer Council Victoria can continue to support projects, including for low survival cancers like ovarian. 

The now-28-year-old has also lost both of his grandpas, a friend from uni, and his family dog to cancer in the months and years that followed his dad's passing.

He decided to fundraise to honour them and "everyone else who has fought this horrible disease".

"At first, I set a very lofty target of $5,000 where I didn't know how long I would need to keep that page open to reach it, but I was going to come up with creative ways to raise those funds," Will said.

Over the nine years that followed, Will has raised an incredible $24,000 for Cancer Council through many fundraisers - ranging from easy ideas to the more ambitious.

The Warrnambool-based man also has walked the track at his local Relay For Life, volunteered at a Daffodil Day stall every year and even shaved his beard all for a good cause.

The cancelling of physical Relay For Life events and Daffodil Day sites in 2020 just made Will more determined than ever to fundraise.

He set up a video chat with his friends and family where they all took on a challenge to walk, run or paddle for 15 hours, checking in with eachother online along the way.

Will ended up walking 30km, with the whole team keeping the baton moving for 15 hours, from 5am to 8pm, doing 551km in total.

In a year with restrictions and challenges, Will's determination was incredible. And he's going to continue to raise money to help other families in the future.

"I saw how awful it was as a young boy losing my dad, and I don't think I'll ever forget the very end of life when they're in so much pain," explained Will.

"Finding out how to stop or slow one type of cancer, supporting one person that's fighting, or one family whose lost someone, anything like that is enough for me to keep fundraising."

Our staff and students were involved in many aspects of the response, including data entry and cleaning, data analysis for politicians and the media and preparing the daily situation report for the Department of Premier and Cabinet and the Chief Health Officer.

They also assessed the epidemiological evidence to link cases and close contacts to known outbreaks, prepared reports on known outbreaks, and undertook rapid literature reviews to inform public health policy and strategy.

Deputy Head of Cancer Epidemiology, Associate Professor Brigid Lynch, said that Cancer Council Victoria staff and students were very pleased to be able to respond and help their community through this public health crisis. While the work was intense and there were tight deadlines, especially during the second wave, there was a strong sense of camaraderie amongst the team.

“We all learned a lot about health protection – how multidisciplinary teams are needed to respond to public health events, such as a pandemic. It was very interesting to see how field epidemiologists work on a day-to-day basis.

“For the most part I think we (as cancer epidemiologists) were mostly learning from the infectious disease epidemiologists and field epidemiologists. But as we got further into the pandemic, and we had time to really analyse the data to address specific questions, our causal inference knowledge and analytic skills were put to use.”