Episode 071: How to Make Self-Care a Priority When You Have Cancer

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In this episode of Simplify Cancer Podcast, we talk about better ways of dealing with prostate cancer with our special guest is Professor Jeff Dunn, Chief Executive Officer of Prostate Cancer Foundation of Australia.

Jeff is an expert in cancer control and has helped to create better supportive care and quality of life for those with prostate cancer.

Here is what we cover in our discussion today:

• Understanding your own support needs
• Objective measure of distress
• The diversity of prostate cancer and what it can mean for you
• Where to turn to for support in a time of need
• Understanding the impact of cancer
• Jeff’s contribution to the global response to cancer
• and much, much more!

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Full episode transcript (PDF)

Episode Transcript:

Joe:                             Jeff, thank you so much for being here.  I’ve been really looking forward to talking to you.  Welcome to Simplify Cancer Podcast.

Jeff:                             Thank you, Joe, it’s my pleasure.  I certainly appreciate the invitation.

Joe:                             Jeff, you’ve done so much, so many fantastic things in the world of prostate cancer.  I wanted to ask you first, Jeff, what is different about men facing cancer?  Do we have different needs?  Do we express things differently?

Jeff:                             There are some differences.  By in large, and as a generalisation, people talk about men being more problem focused than women.  Men will collect information to try and solve a problem.  Women, once again, this is a generalisation, people talk about women being more interested in that connection, in that communication style of coping strategy.  Look, there are differences.  As an overall comment, I’d say that cancer patients, irrespective of gender are not passive recipients of support.  When faced with a life-threatening disease, people, men or women, will make choices based on the information at hand and have personal preferences about how they receive information, support, and services.  It’s a difficult one to generalise, Joe.

Joe:                             Yes, absolutely, Jeff.  When you’re diagnosed with cancer, it just flips your entire world upside down.  Jeff, what would you say to someone who has been newly diagnosed with cancer and may be struggling to really come to grips with their disease?

Jeff:                             Joe, first up, for someone who’s newly diagnosed, the message is, from all of our evidence and all of our research, that most people do well over time.  It gets better.  Not for everyone, but for most people.  I think that’s the important message.  If you’re newly diagnosed and you’re finding that you’re working out how to deal with this, seek out information for a start.  Find information.  Be prepared to talk to other trusted friends, if you want to.  Certainly, do talk to people.  Use those supports that are around you.  For many of us, there are supports around us.  You can always go to reputable sources.  If it’s cancer, cancer councils or Prostate Cancer Foundation Australia, or Carers Australia, or the National Breast Cancer Foundation.  You can find these sorts of reputable organisations.  Of course, your healthcare team, certainly talk to them about how you’re feeling, to your general practitioner, or if you’re seeing a psychologist or whoever, but talk to them about how you’re feeling and how that’s going.  Remember that there are things that can be done to help.

Joe:                             Yes, I think that’s such a huge point that you make, Jeff, about really exploring all sorts of different possibilities to get help.  It shouldn’t be just one thing, but there are so many options.  I think the more tools you have to help you get through it, the better it is.

Jeff:                             Look, without a doubt.  That’s what I always say, people seek out things that suit them, each of us have different ways of coping or gaining knowledge or making decisions, of assessing choices.  It’s important that we look at providing just an answer or not just one option, but a multi-layered suite of potential responses to provide for individual needs.  Remember, those needs vary over time.  What people need at the point of diagnosis might well be different to what people need six months and twelve months down the track.  Once again, it depends on their cancer, on their diagnosis, on their treatment, on their own makeup, on their family, on their community, on their sociodemographic, on their financial needs.  All of these things play a role and it’s complex, but it’s important that we understand their things we can do, and things can get better.

Joe:                             Yes, exactly.  As you say, Jeff, we have different ways that we respond to thing.  Really, as a behavioural scientist and a researcher in cancer control, what would you say are your observations about how cancer impacts people in a different way?

Jeff:                             We’re all different.  When you think about people’s response to cancer, it’s about individual responses.  It’s about the psychological makeup, it’s about their social response to their communities, about how they’ve grown up.  Their sociodemographic situation.  Their ethnicity, their cultural backgrounds.  All of these things impact.  They all influence.  They all mediate response.  Of course, there’s no one thing, which, again, points to the importance of looking for a range of responses, a range of channels for patients who are diagnosed, so that we put them in the middle of this and provide them with options to make choices in ways that best suit themselves.

Joe:                             Yes, that’s great, Jeff, because it’s all about knowing that options are available and then choosing what’s right for you.  Jeff, I really remember going through cancer and thinking, this is cancer.  It’s supposed to be hard.  You get caught up in your experience.  Sometimes it doesn’t occur for you to seek help.  How do you really know that you yourself might be struggling with something and you might need help?  Is there an objective measure to get a handle on stress?

Jeff:                             Joe, there are a couple of things and thanks for sharing your story and you’re right.  A cancer is a life-threatening disease.  When someone’s diagnosed with cancer, it’s usual to be concerned about that.  To feel a threat.  It’s okay to be a bit concerned and worried and those sorts of things.  People need to understand that.  It is a threat to wellbeing, and everyone responds to that differently.  In the early stages, of course, it’s about understanding what means for you and how you cope with it.  In terms of objective measures for assessment.  Look, it’s not unusual for people when they first get a diagnosis, their sleep patterns are disrupted, they might be a bit more irritated than they usually are.  Their concentration might be reduced.  I think what’s important for people is to be able to assess or think about when those sorts of things get to the point when they have a significant or meaningful impact on their lives or on their relationships or on their work.

They are the points in time where you might actually start to put your hand up and say, maybe I need to talk to someone about getting some advice or support or assistance or starting to talk to others certainly about that.  From a professional point of view, health professionals, we have some tools we can use now and one of those is a distress thermometer, which we’ve been putting in place and trying to understand a standard care when a diagnosis of cancer is being made, so that health professionals themselves have got an objective measure when it comes to trying to assess how people are coping from a psychological, social, and emotional point of view.

Joe:                             Yes, that’s fantastic, Jeff.  Tell us about this distress screening tool.  How can it help me, or others diagnose?  How can it help when you’re struggling?

Jeff:                             I think when we’re talking about people’s emotions and their feelings and anxiety, they’re abstract sometimes, aren’t they?  They’re difficult to actually measure specifically.  It varies so much across people.  The distress thermometer is a very simple point scale, one to ten.  It’s accompanied by a symptom checklist, so that we can actually go through specific items that might have an impact on that person.  Essentially, we’re asking people, on a scale of one to ten, how would you rate your level of distress right now.  We know from all the evidence that it’s validated, that it works.  We know that people who score four and above are more at risk for ongoing distress and anxiety.

By putting the distress thermometer in, we have an objective measure.  Particularly for health professionals in this sense because it starts the conversation.  If you have something like a distress thermometer, you say to someone, let’s talk about that now, and someone has a rating of four or above, then you can start that conversation.  These sometimes are conversations that might not happen unless you had something like the distress thermometer in place.  We see a whole range of benefits coming out of this and once again, we know from all the evidence that it makes a difference, and it will work.

Joe:                             That’s fantastic, Jeff, because it leads you on a path to discover and I think what I really love about it is it helps you to self-identify some of those problems.  It’s the patient who’s saying, “Listen, I’m maybe struggling in this area.” As you say, this can lead in the treating doctor to ask more questions and to help them deal with it, right?

Jeff:                             100%.  It starts the conversation.  Sometimes, as I said, these conversations don’t get started and the thermometer provides permission for both the patients and the clinician to actually talk about things.  You start with an objective measure that says, today, I feel pretty distressed.  I’m a six or a seven.  There are things that can be done that provides a clinician no advice.  The clinician then can work with the patient and take the necessary interventions or make the necessary referrals if those are necessary.

Joe:                             Yes, absolutely.  Speaking of that, Jeff, really, we’re talking about many different approaches to psychological treatment, with people experiencing cancer related to stress and worry.  If you’re going through cancer and it’s getting a bit too much, where do you turn?  Do you look for a psychologist?  Is it a psychiatrist, is it a council?  Who’s going to help you?  Also, how do you know who to trust and who’s advice you should take?

Jeff:                             Terrific question.  Come back to basics, in the first instance, talk to your doctor.  Identify reputable sources.  Once again, cancer councils, or Prostate Cancer Foundation from reputable sources.  Health department sites, where they will provide information and talk about options.  If you talk to your doctor, you can get referrals to psychologists or psychiatrists, if necessary.  Each of these professions.  Councillor, psychologist, psychiatrist each have a role to play and in somewhat different ways on occasion.  They each have a role to play.  Once again, your general practitioner or your family doctor or reputable organisations will be able to help direct you in that regard.  I think it’s important to understand that once again, there’s no right answer here, Joe.  I think for patients out there, it is a matter of saying, I think I need to talk to someone.  If you’re not sure where, go to a doctor, go to your GP, or go to a cancer council or prostate cancer foundation helping, if it’s a prostate cancer, for example.  They are the people you can start.  Then you start to get the referral points out.  Depending on what your particular needs are.  That’s important to assess, as well.

Joe:                             Yes, absolutely, Jeff.  Let’s say you do get directed to a specific professional, you spoke to having different needs and preferences.  How do you really know that this is the right person for you?  Like, just in the way that speaks to you on a personal level.

Jeff:                             It’s critical that you can speak with these people on a personal level.  There’s a concept called therapeutic alliance, which is crucial in these aspects, which is how the patient and the clinician connect.  It’s very important.  If you’re seeing someone and you’re talking with the clinician via GP or a psychologist or a psychiatrist or a counsellor, you’re not actually resonating.  That person doesn’t seem to be on your wavelength.  It’s okay to actually recognise that and then you get a referral to someone else because depending on the individual therapy or the particular approach or the clinician or whatever, they will take their own approaches.  As we spoke about it earlier, patients aren’t passive recipients of support.  We actually make decisions on the value of things based on how well they resonate and connect with us as individuals.  If they’re not doing that, it’s important to find a source of support that does resonate with you.  You can ensure that that therapeutic alliance is working well.

Joe:                             That makes so much sense to me, Jeff.  It’s okay to seek a different opinion or a different perspective.  Someone who you really might gel with better.  It also raises a question in my mind, Jeff, when it really comes to seeing a psychologist or a counsellor.  Sometimes you don’t really know what to expect.  Especially if you might be already in a high level of distress, you might be dealing with cancer.  Is it going to feel unnatural?  Are you going to get asked personal questions that you maybe don’t want to answer?  Do you see that as a problem, Jeff?

Jeff:                             Again, it comes back to fit in that alliance.  Psychologists will have their own way; each psychologist will have their own way of approaching a person’s needs and delivering therapy.  So will each psychiatrist and so will each counsellor and so will each sports and exercise physiologist.   It’s a matter, again, for the patient in that circumstance to make assessments about how well that’s working for them.  To be prepared to acknowledge when it’s not and to seek alternatives.  Professionals, whether they’re psychologists or psychiatrists and others will have, in most cases, the ability to adapt and to assess and to measure in that relationship, whether they’re connecting and change styles to suit.  In the end, if it’s not working so well, you need to actually look somewhere else.  It will be personal questions, but it’s about how they’re put.  It’s about the level of comfort you’ve got with that person, about how it’s introduced.  Then, again, about what’s done with your answers?  Again, it speaks to the importance of the relationship between the clinician, the therapist and the patient.

Joe:                             That’s a great point you’re making, Jeff, about the fact that if you’re a professional, you can change styles and adapt.  I think that’s a really important point to note, because sometimes it’s easier to talk to a psychologist or a counsellor, as opposed to someone who’s already a part of your life, like your partner or a friend, because they don’t know you, but they know how to listen and they know how to approach different situations to help you through it.

Jeff:                             100%.  With friends and family members, there are some things that you talk about openly.  There may be some issues and concerns and fears that you can use that objective assessment of a professional, whether it’s holding up a mirror and allowing you to process some stuff, or to take you through a particular process in a logical sequence to arrive at a decision.  That is important and is not something that family members are well placed to do.  Maybe because family members and friends, they care about you.  They love you and they’ll say things to you and for you and with you and do things which are all about support and care, without that professional structure to guide some of that intervention.  Of course, we all go back to our personal life, perhaps there are some things that you want to talk about which you want to keep personal to you and perhaps professional and not raise with family members.  There are differences.  Families and friends provide fantastic support.  In many cases, it’s all patients will need, and they’ll work through and process it themselves.  On occasion, there are some interventions which can be professionally delivered.

Joe:                             Yes, absolutely.  I think you know the more help you can get, if it works for you, I think the better it is.  Jeff, when we look at our society and I think it relates to some of the things that we’re talking about now because of the complexities involved.  It sometimes seems to me that we try to find simple solutions to what maybe be complex and multi-layered problems.  Where do you think we should place our focus?  What should our priorities be in this instance?

Jeff:                             Joe, you’re right about society.  It’s changing, isn’t it?  It’s complex.

Joe:                             Yes.

Jeff:                             I have to say, sometimes the simple things are the best.  I’ve seen it happen.  The warmth of a touch or the openness of a smile, the touch of a hand can sometimes has a profound effect on how people are feeling and how they respond.  Sometimes going for a walk just to clear your head can do terrific things for your affect, for your mood, for how you feel about things.  Simple things can and do make a big difference.  We mustn’t lose sight of those.  Let’s remember that they can be critical.  Having said that, depending on an individual’s experience, there are some things where coping becomes tough.  Some cancers have morbidities and side-effects that challenge over time.  Over long periods of times.  People’s response can vary and so, again, it’s important to understand that close personal support networks are critical.  I addition to that, a range of programs and services, again, where we have referral options for patients, depending on their need and their preference, will make a difference.

Joe:                             Absolutely.  That’s fantastic, Jeff.  Listen, I know you launched a new psychosocial model of care for men with prostate cancer.  Tell us, what led you to develop the model and how does it work?

Jeff:                             Well, we were working on the distress thermometer, of course, as we’ve discussed already.  Once we published that and we have a positioned statement on screening for distress, I think it was important then that we had a look at all of the evidence about potential points of referral.  We produced a monograph on psychosocial care.  Look, essentially, it’s a self-help book for professionals who are dealing with cancer.  What we’ve done, we’ve gone through and we’ve identified all of the potential interventions or all of the evidence-based ones.  We summarise those to provide advice, evidence-based advice to clinicians who are working with cancer patients.  It runs all of those things.  It covers things on exercise.  We mentioned, by the way, exercise is a very important intervention and there is a lot of evidence for it, just to keep active, it’s very important.  Positive behavioural approaches.  Stuff around psychosocial education, education work, coping skills, training, problem-solving.  A whole range of things we’ve included in that monograph.  That’s available for health professionals when they’re working with cancer patients.  It’s proved to be very useful.

Joe:                             It’s great I think, Jeff, that it’s got what you’re talking about.  It’s essentially a toolkit with your different tools that you pick out and to apply, to help people wherever they’re at.  It could be multiple things.  Someone might need help with exercise, or they might need some kind of therapy and it really depends, it really sounds like something that you can suit to a specific situation.

Jeff:                             Exactly right.  Once again, sometimes it’s the simple one.  It’s having a supportive family network.  Or it’s talking to someone else that’s shared that experience.  Peer support.  For many cancer patients, peer support is the preferred method of support, what is of greatest benefit to them is actually talking to someone else who’s been diagnosed with that cancer and has gone through that experience and can validate their feelings, can share their experience and can make them feel that they’re not unusual, as they face what’s ahead.  It’s important that there’s a whole range of these.  They’re not all complicated psychologist or psychiatrist delivered complex interventions.  Or they’re not all about pharmaceuticals about drugs.  There are a whole range of things that we need to keep in mind.  Some of them are about that simple human connection.  Information and connection as well as some of those more professionally delivered ones.

Joe:                             Makes so much sense, Jeff.  I want to just touch on the support groups that you brought up because I think that’s such a hugely powerful tool and ways for people to see help.  As you said, it’s really filled with people who know exactly what it’s like.  For me, I joined this online support group.  I know that for me it made a huge difference because it was really filled with people who can identify with your experience, who can really get you.  In my experience, it has been not only really helpful, but it also is something that can help partners, as well, right?  For example, you could be going through cancer, it could be great for partners to talk about their life, in general.  You don’t have to go and specifically hear things that might be really personal to you, you can just talk about whatever you feel comfortable with.

Jeff:                             100%.  Peer support.  Whether it’s one-on-one, whether it’s one connection or whether it’s going to a group meeting.  Whatever it is, it’s a powerful piece of therapy.  There are things that a peer supporter can do that a clinician or a psychologist, no matter how well-trained they are, can never do.  It’s that shared personal experience, which is such an important ingredient.  Unless you’ve gone through that journey, as you’ve just said, it’s difficult for people to validate someone’s experience.  If you’ve done it yourself, you can share that.  There’s a level of understanding.  The mechanisms we try to understand, but that shared personal experience is something very precious and peer support as we’ve just been talking about is a very important channel for people diagnosed with cancer.

Joe:                             Absolutely, Jeff.  Speaking of the power of experience, did you think any of that, the challenges that we go through for those of us with cancer, are there any challenges that are kind of unique to us here in Australia, do you think?

Jeff:                             Look, we’re all people.  We get diagnosed with a life-threatening disease, of course that’s a challenge for us, then our cultural, our ethnic backgrounds.  Our psychological makeup, our social circumstance, all of those sorts of things will help mediate that response.  In Australia, we share with some other countries.  Our geography can be a challenge for some, for sure.  We’ve got people in remote communities, we do know from our research and evidence that sadly even in Australia, our country, our regional friends, colleagues and family members don’t do as well when a diagnosis of cancer is made.  For a whole range of reasons and some of which we’re still struggling to understand.

Geography is an issue.  Certainly, we have vulnerable populations, like other communities and countries in the world too.  Some of our indigenous Australians, some of our migrant populations with language barriers.  We have those issues, as well, but we’re not unique in sharing that.  Countries all around the world have their own particular issues.  What’s important is to try and share the knowledge globally so that we can all work out what works where?  How do we make a difference?  Then make sure we apply that as can in each of our own communities.

Joe:                             Yes, absolutely, Jeff.  I guess that also speaks to what we touched on earlier, is that there are so many different aspects around it, and we want to be able to manage them well, just in terms of specific situations.

Jeff:                             Exactly right.  I think we as a community need to just understand that, certainly the health professionals in our community need to understand that.  We just need to look at ways.  For us, a big issue right now is how we share the benefits of our technology equally throughout Australia.  Why is it that regional cancer patients don’t do as well?  What do we have to do to make sure that they share in the benefits of technology and communications and research, as well as people living on the eastern seaboard or in southwestern Australia around Perth?  Those are the sorts of things that we’ve got to address along with others, of course.

Joe:                             So true, Jeff.  Speaking of different perspectives and the way people perceive things.  I was reading a research paper called: Not all prostate cancer is the same.  I was really struck by the significance of just how diverse prostate cancer can be, just in terms of its aggression and how we need to look at it through the perspective of supporting really the patient’s wellbeing and really making decisions about their treatment.  What’s your perspective around that?

Jeff:                             You’re right.  Not all prostate cancers are the same.  There is lots of work going on to try to better inform how we identify different types of prostate cancer.  Those which are slow-growing and are really not going to do much, best to leave them alone.  Then those which are aggressive and there are differences.  Of course, overlayed on that, there’s a whole range of treatment choices for prostate cancer.  There are decisions to be made.  Again, what’s critical is for the person with prostate cancer, the man on this occasion, the person with prostate cancer being close to their clinician, to their general practitioner and to their healthcare team to gather information.  That’s really important, to get good information.  To have a good relationship with your healthcare team and make sure that you cultivate that, so that you can get support in making decisions and making choices, so that you have the best quality choice you can with the information at hand at that time about your treatment.

Joe:                             Yes, absolutely.  It’s all about choices and that’s something that continues to come up in our conversation.  That makes a lot of sense to me.  Listen, Jeff, I know that one of the areas of focus that you have is really survivorship.  Do tell me about what some of the latest research is that you’ve done around that.  What does it really mean for a man with prostate cancer?

Jeff:                             Joe, I’m glad you asked that question.  Survivorship is critical.  Just to put it in perspective a little too and I’ll talk about Australia at the moment, our figures, but in Australia, we have some of the highest incidence rates of prostate cancer in the world.  The highest numbers.  The two biggest risk factors still for prostate cancer are age and family history.  In Australia, there are more men and we’re all getting older as a population.  The numbers of men dying with prostate cancer in this country in terms of absolute numbers is going to increase.  There are going to be more and more men out there with prostate cancer.  The flipside, happily, in Australia again, for example, our survival rates, five-year survival rates is a statistic.  We spoke about this earlier, Joe, but I’ll use one now, our five-year survival rates which is a benchmark we use to see how well we’re going, our five-year survival rates are among the best in the world, as well.

We’re world-leading in that because our clinicians, our doctors, our nurses, our allied health people, the health system is doing a great job.  It means that we’ve got more men being diagnosed and we’ve got more men living longer.  Much longer with this disease than they ever were.  Survivorship has never been more important.  We’ve got more people out there that are living longer after a diagnosis of prostate cancer and for some of them, of course, there will be ongoing issues to do with physical side-effects, sexual function, incontinence, pain, as well as social/emotional/psychological side-effects, potentially.  While it’s important, it’s critical, we want people with prostate cancer to live longer.  We want to make sure that we improve life expectancy, but we also want them to live well.

That’s where the survivorship comes in.  To make sure that they live well, quality of life.  We’ve been working hard on that.  We’ve developed new support and a lot of consultation with clinicians and survivors and partners.  Prostate cancer survivorship essentials framework, which has identified six key elements of survivorship.  What’s important in this new framework is the role of personal agency, which is in the middle of it, which is about an understanding by the prostate cancer survivor themselves.  The man in this case understanding there’s actually a role for that in this and not to be passive and to help understand how personal agency can improve that survivorship experience for people after diagnosis.

Joe:                             It’s so crucial that you bring it up, Jeff, because this personal agency really to me speaks to that crucial feeling for a man is really to feel like they’re in control of their life.  To feel that they’re making active decisions.  They’re doing something.  Earlier, as you were talking about having the problem focused approach, to feel that you are doing something in order to have the life that you want.

Jeff:                             100%.  That’s right.  We spoke about that earlier.  There are things that we can do.  There are things that individuals can do to understand what’s going on around us.  That issue about personal agency, the connection with the healthcare team.  Understanding the information, being a part of that decision-making process.  Trying to influence that in ways that would actually reflect your own personal preferences and approaches can make a difference.  Personal agency is a concept that we’ve added to the framework.  It includes health promotions.  Looking after yourself.  Evidence-based interventions.  If you’re going to try and do something and seek our ways to improve your own quality of life, it’s important to look at ones where we know there’s evidence.  There are a lot of things out there, but we’re not quite sure they all work.  Vigilance.

There are things we can keep an eye on, for the healthcare team and for the person.  If you’re meant to be going and having tests, we’ve got to make sure the healthcare team, even things like distress.  Check on people’s psychological wellbeing from time to time from a vigilance point of view.  Care coordination is crucial, too, Joe.  Making sure that everyone is a part of that care program or the healthcare team actually coordinates so that men get the right care in the right place at the right time and don’t fall through the gaps, which is critical, as well.  The other thing we’ve already spoken about is that shared management.

It’s a partnership between the patient and the healthcare team and their families and who’s got what roles where and how you ensure the best possible outcome for people.  We have a framework for survivorship with personal agency at the centre and we’re actually promoting that as a way for policy makers and health systems, for clinicians and for individual cancer patients and their family members to approach survivorship care.

Joe:                             Yes, that makes total sense, Jeff.  It makes me also think back on what we talked about earlier about partners, because I often feel that sometimes partners don’t get the recognition or the support that they truly deserve because we don’t look at them because they don’t have the cancer.  Yet, they are often doing so much work and supporting their loved one through cancer.  I know you’ve done a lot of work on researching the impacts on all that cancer can have on partners and the community, as well.  Tell me more about how cancer can impact that around us?

Jeff:                             Well, Joe, you’re 100% right again.  For example, we need to understand that cancer impacts that individual who’s received the diagnosis, of course, but it has significant impacts on partners and families and close friends and relatives.  Sometimes on whole communities.  We’ve seen stuff where a much loved and respected community members have got a diagnosis of cancer and it’s impacted whole communities.  It’s important to understand that.  We know from research, for example, female partners of many cancer patients actually report higher levels of psychologist distress than the person with the cancer themselves.  This may be mediated a bit by gender differences and how women tend to express distress, but it reinforces your point.  That a cancer diagnosis needs to be seen as having an impact beyond the person themselves.  There are, once again, support services and programs that we can work with and encourage coping, effective coping for partners.  The first step is to acknowledge and recognise that this can be an issue, that is does happen.  That’s where awareness out there is critical.  Partners and families 100% are impacted by a cancer diagnosis.

Joe:                             Yes, absolutely, Jeff.  We also talked about some potential challenges that we might have here in Australia and that might be with just how geographically diverse we are.  It also makes me think about technology.  How can we harness technology in a way that really helps to connect people with support that they need?  If so, how can it do that?  Are there any barriers you have observed to take that up, really?

Jeff:                             First up, technology, we’ve been using it for a while in different ways.  For example, we’ve had telephone-based peer support programs for some time.  We know they work, and they’ve been out there, where we connect via telephone, people who have had a cancer experience with newly diagnosed people.  All of the evidence and evaluations, it’s a truly good invention.  We’ve had telephone-based nursing stuff.  You will have heard about telehealth and telemedicine and that was all commencing and in play and doing well.  It’s a critical part of service delivery without a doubt.  Notwithstanding all of the impost and the troubles caused by Covid-19, perhaps a silver lining to some extent is it has fast-tracked our approach to delivery of remote health services around the world.  We know now.  It’s normalised remote delivery of services much more quickly than probably would have happened otherwise.  It was probably going to happen, but it’s happened much more quickly.

We see much greater acceptance now and a much greater prevalence of remote delivery services via telephone, via websites, via webcast, or via all other sorts of technologies.  People’s willingness to accept them, experiment, try these has also improved.  It’s given permission to people to try these things.  We know they work.  Can I just tell you, for example, we’ve done research some years ago now and there is plenty of evidence out there to support this that telephone-based psychological services by a trained psychologist for most patients can deliver the same therapeutic impact as a face-to-face psychological intervention.  Now, there are always exceptions.  There are going to be certain circumstances or issues or challenges or problems which we better deal within a face-to-face environment.  That is always going to be the case.

Do you know what?  There are a lot of things that we can deliver remotely, and we know that.  As we’ve said, in Australia, that will be a relief for our friends in the regions who won’t have to travel long distances.   My only warning about this is, once again, there are some things, particularly depending on the diagnosis and depending on issues that people are facing, there are some things that will always require face-to-face interaction.  What’s important for us is to recognise that for most people, we can address their needs in different sorts of ways and then we can continue that referral process.  If people need more face-to-face activities or more intensive stuff, then we can at least identify them through that screening process and then start that referral process to make sure that they’ve got the service they need.

Joe:                             Absolutely.  I’m so relieved to hear what you say about the efficacy of remote services like over the phone or video because not only for the regional people who are living in the regional areas, but in the times that we live now, with the pandemic, where in many ways, we are forced to be in our homes or not travelling and getting that quality support, whether that’s a psychologist or something else.  I think it’s so crucial.

Jeff:                             It is.  We are facing an awkward period.  We’ve not experienced this before as a community.  It’s important that we as a community look to build on those interventions and approaches and channels we’ve currently got which allow us to get to people remotely.  At the same time, look for new and innovative ways to deliver services.  We need to focus on that.  That’s got to be a priority for us.  It’s good to see that the community at large is embracing that, and the health professionals too are committed to patient welfare and they’ve made it a priority.

Joe:                             Fantastic, Jeff.  Thanks for sharing that.  Jeff, I heard that you’ve recently been appointed president elect for the union for international cancer control.  Congratulations, Jeff.

Jeff:                             Thank you, Joe.  Yes, well, it’s terrific.  The UICC is a global peak body for cancer control organisations.  It’s based in Geneva.  It’s been around for 85 years.  It was founded in 1933.  It’s a terrific honour for me.  Can I say, Joe?  It’s an honour I need to share widely because I’ve been in cancer control for three decades now.  I’ve learned every day from friends and colleagues and professionals that I come into contact with.  Most importantly, I’ve learned lessons every day from interaction with cancer patients and their family members and friends.  These are the lessons that motivate me and inspire me to continue in this line of work.  This UICC appointment, I’m delighted with it and I’ll be using it, I can assure you and your listeners, to leverage everything I can to improve cancer control outcomes in Australia, but, of course, more importantly, globally, as well.

Joe:                             Yes, that’s fantastic to hear, Jeff.  Congratulations on that.  What are some of the things that you hope to achieve there?

Jeff:                             This year around the world, they’ll be about 18 million people diagnosed with cancer.  It’s a big number.  This year, around the world, they’ll be about 9.5 million people die from this disease.  That’s a tragedy and we need to do something about that and we’re working at it.  Those numbers, as we look at them now, they’re going to go up.  For example, we estimate that by 2030, which is 10 years down the track, that 9.5 million deaths each year will be 13 million.

Joe:                             Wow.

Jeff:                             That’s another 3.5 people every year who’ll die from this disease.  As we’ve spoken about, that 3.5 million mothers or fathers or sisters or brothers.  That’s 3.5 million additional people.  We need to work on these things.  The concerning stat is that of that 13 million deaths we’ll see in 2030, about 80% of those will be in low to middle income countries around the world.  There’s a job to be done in equity.  There’s a job to be done in sharing the technology, in sharing the benefits.  That remains an issue for the UICC and do you know what?  We spoke about it earlier, it’s still an issue for us in Australia too.  How do we bring together that global community, that global cancer control community to make sure that we fund the right research, and we share the benefits of that research well?

That we improve treatments and make them readily available no matter which country you live in.  Those are important issues for us.  Another important project we’re looking at.  We’re working very closely with the World Health Organisation on the elimination of cervical cancer program.  Can you imagine that a world that’s free from cancer of the cervix?  This is something we’re actually looking at.  It’s something we’re working towards.  It’s a possibility.  We’re delighted in that.

Joe:                             That’s fantastic, Jeff.  So relieved to hear that you’re tackling these huge issues around cancer.  Thank you for doing that.  Thank you so much for being here, for sharing your perspective and your expertise, as well.  Thank you, Jeff.

Jeff:                             Thank you, Joe.  I appreciate it very much.