The advances in cancer treatment for the last three decades have seen a significant improvement in survival following childhood cancer, with cure rates approaching 80% in some developed countries. However, most of these survivors develop long term side effects, such as ototoxicity, secondary to their medical treatment (surgery, chemotherapy, radiation and immunotherapy). Despite the varied nature of childhood cancer, existing studies show a high incidence of ototoxic hearing loss amongst young cancer survivors. A hearing loss caused by ototoxicity can have a negative impact on communication, speech and language development, cognitive and learning abilities, academic progress, psychosocial relationships and vocational opportunities. The purpose of the present study was to investigate firstly, the audiological habilitation management and ongoing communicative needs for these children and secondly, the perception of carers and their children about the effects and risks of cancer treatment on hearing, and the children’s quality of life. The participants in this study included 13 children (who received anti-cancer treatment for medulloblastoma, neuroblastoma, hepatoblastoma, osteosarcoma and astrocytoma) and 17 carers. Audiological assessment and management data were obtained by an audit of all children’s files held at respective hearing centres. Quality of life data were obtained through face to face interviews or by phone interview using the Sunshine Hearing Analysis (SHA) developed specifically for this population. The audiological assessment data showed that all child participants had audiometric configurations typical of an ototoxic hearing loss with poorer hearing thresholds in the high than in the low frequencies. All child participants required habilitation services provided by Australian Hearing, Education Queensland and State Health Services to different extents, which depend on the severity of the hearing loss. These habilitation services included provision of counselling by health and allied health professionals, amplification devices, special education services, learning support from advisory visiting teachers, speech therapy, occupational therapy and oncology outreach programmes. These services provided the most needed support to the affected children and their families to improve their quality of life. The SHA data revealed that child participants had better functioning in the social than in the emotional and physical domains, suggesting that they coped quite well in their social life, despite having the inevitable negative side effects arisen from their medical treatment. The child participants with a moderately-severe to severe high frequency hearing loss and those who were treated for medulloblastomas were found to have significantly reduced emotional functioning in a variety of listening situations when compared to their peers. The SHA data collected from carers of the young cancer survivors showed that the severity of the children’s hearing loss had a negative emotional effect on communication and quality of life of their children. In particular, carers of female child participants reported that their children demonstrated significantly lower functioning in the emotional domain than that reported by carers of the male child participants. In conclusion, although hearing loss caused by anticancer medical treatments is seldom a reason to stop treatment of cancer, the findings of the present study indicate that the resulting permanent hearing impairment can have a negative impact on children’s communication, learning at school and, consequently, their quality of life. These children should be given sufficient and appropriate ongoing habilitation services to reduce this impact and, hence, improve their quality of life.

There has been a significant increase in the use of amphetamine type stimulants (ATS) in Australia over the last decade, and according to the National Drug Strategy Household Survey (2004) results, amphetamine is the second most commonly reported illicit substance used by Australians after cannabis. It has been widely documented that illicit drug users, and in particular ATS users, experience high levels of psychiatric comorbidity and particularly high levels of depression. Depression is one of the leading diseases in the modern world and causes significant burden to those who suffer from it. The main aim of this study is to determine the levels of depression among a sample of regular amphetamine users and investigate the subjective experience of life quality among those with comorbid depression and those without. This study was a separate component of a randomised controlled trial for regular amphetamine users in Queensland and New South Wales (Baker, Lee, Claire, Lewin, Grant et al, 2003). Participants were required to be 18 years and over and regular users of amphetamines as defined by use of amphetamines on at least four occasions in the previous month. A total of 2 14 participants were recruited from a range of sources into the study. Levels of depression (measured by the BDI-11), quality of life (WHOQoL BREF), dependence status (SDS) and drug use patterns (OTI) were all examined. High levels of depression were found among the same with 84.6% of the sample reporting clinically significant depression with a large proportion of this group falling into the moderate to severe spectrum (7 1 %). Results identified several areas of major risk for poor quality of life for amphetamine users, including dependence, frequency of use and route of administration, and showed how these risks areas can be compounded by level of depression to create significantly decreased quality of life. No amphetamine withdrawal scales were administered in the assessment protocol for this study. It is possible that some of the reported symptoms of depression could be related in part to an amphetamine withdrawal syndrome. Further study of the natural history of withdrawal and the prevalence of related metal health symptoms is warranted. This sample was a treatment seeking, dependent group of amphetamine users. The results confirm the high rates of mental health comorbidity among regular amphetamine users and highlights the added burden of disease that this group suffers. The results have implications for treatment services, which need to manage both comorbidity and individual aspects that contribute to an improved quality of life. Further analyses examining treatment outcomes for this group would be useful.

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