Icon Group Strate

2022 ANNUAL REPORT

EXECUTIVE SUMMARY

The Clinical Care team sits within the broader Icon Group Strategic Investment and Clinical Care (SICC) team. The Clinical Care team is a group level team spanning Icon’s global cancer services and extends across radiation oncology (radiation therapists, medical physicists, and nurses), medical oncology (nurses), molecular oncology, and quality and risk.

The team provides several governance functions within Icon, including leadership of the Group Practice Units and clinical incident management, and also provides leadership and support for the operational cancer care teams as well as leading development and implementation across the cancer care divisions.

This annual report provides an overview of the clinical care team and their 2022 achievements and highlights. These highlights include supporting the setup and successful implementation of radiation therapy services across five new locations globally including design, recruitment, training and accreditation, delivering educational sessions and content to the cancer services division, and establishing the Group Patient Safety Committee, Nursing Practice Unit and Molecular Oncology Practice Units. The team also advocated for an Icon Nurse Graduate Program, implemented a global medical physics structure to support operations and technology implementation, and continued to support the cancer services divisions with Icon Plan seeing record monthly numbers of radiation therapy plans being generated throughout the course of 2022.

2023 OUTLOOK

2023 will see the Clinical Care team continue to effectively support the various divisions across Icon’s global footprint and build upon 2022’s achievements.

Within Australia and New Zealand, technology uplift will continue to be a focus with several exciting projects and initiatives. This will be supported by ongoing enhancement and development of education and training systems, as well as the systems to support clinical governance.

Globally, the Clinical Care team is well positioned to scale as the business grows into existing and new geographies, and will continue to embed the required systems and support functions that are now well established and highly effective across the network. Technology uplift will also remain a focus, especially within the stereotactic radiation therapy setting and continued evolutions of treatment technology.

CLINICAL CARE LEADERSHIP TEAM

The Clinical Care team is led by the Group Directors of Nursing, Radiation Therapy, Medical Physics, Molecular Oncology, and Quality and Risk.

2022 saw the ongoing investment in the leadership and investment of regional structures and recruitment of expert clinical team members to continue to deliver best-practice services across Icon’s cancer services globally.

Trent Aland Group Director of Medical Physics

Trent is the Group Director of Medical Physics and deputy chair of the Group Radiotherapy Practice Unit and a member of the Group Patient Safety and Radiation Medicine Research Committees within Icon.

Trent is a certified radiation oncology medical physicist and has over 20 years experience in the radiation oncology sector. He brings a strong technical, clinical, and research background to the role and is also a proud supporter of Diversity & Inclusion at Icon, being a member of the LGBTIQW+ employee led inclusion group (ELIG) within Icon.

Trent is also on the ACPSEM board of directors where he also serves as the Head of Specialties, and he also holds an Adjunct Professor appointment at the Queensland University of Technology in Brisbane, Queensland. He has also worked within international radiation oncology departments in Qatar and Vietnam and is passionate about innovation and technological development within cancer care while providing the best care possible to all patients.

Trent is supported by the Assistant Group Director of Medical Physics, Anthony Walsh, Group Lead Medical Physicist, Ben Archibald-Heeren, and the Regional Medical Physics ManagersNick Collett, Kelvin Hiscoke, Kellwen Hu, Nigel Middlebrook, Danielle Mulherin, and Mark West whom in turn manage the Icon Cancer Centre based operational medical physics teams within their regions.

Margie Hjorth

Group Director of Nursing

Margie is the Group Director of Nursing and has a strategic role in the development of cancer nurses across Australia and Asia. Margie is also chair of the Group Nursing Practice Unit and a member of the Group Patient Safety Committee and Group Radiotherapy Practice Unit within Icon.

With a strong interest in professional development opportunities for all cancer nurses, Margie is committed to advancing nursing practice in cancer care. Margie is also a subject coordinator at University of Melbourne designing and delivering the radiation oncology nursing module for the post graduate certificate in cancer nursing course.

Margie is supported by the Associate Director of Nursing – Education, Leisa Brown, Associate Director of Nursing – Clinical, Danni Steele, and the Group Project Nursing Lead, Linda McGinn. The Icon Nurse Education Team (INET) are also an integral part of the SICC Nursing TeamAmanda Connolly, Jade Fitzgerald, Danny Kokanovic and Jenn Manning.

Claire Smith

Group Director of Radiation Therapy

Claire is the Group Director of Radiation Therapy and also chair of the Group Radiotherapy Practice Unit and a member of the Group Patient Safety and Radiation Medicines Research Committees with Icon.

After beginning her career as a radiation therapist in Brisbane she has spent seven years in the United Kingdom, predominantly being responsible for implementing new technology and treatment planning and delivery techniques. After returning to Australia she spent time implementing oncology services in regional area’s of Queensland before leading the radiation therapy service implementation of Icon’s radiation oncology service in Mainland China.

Claire is passionate and committed to improving access of care for oncology patients as well as ensuring the highest quality and technological advances are made available to all. Being able to bring state-of-the-art care to regional patients has been a highlight of her career.

Claire is supported by the Group Manager of Icon Plan, Huong Nguyen and the Icon Plan team, Group Manager of RT training and education, Aidan Leong and the training and education team, and specialist leads - Lee Anderson, Nola Bailey, and Louis Huynh.

Julie Crouch

Group Director for Molecular Oncology

Julie Crouch is the Group Director for Molecular Oncology and leads the strategic development of the global molecular oncology business. Julie also chairs the Group Molecular Oncology Practice Unit and is a member of the Group Patient Safety Committee within Icon.

Julie has extensive experience in leadership and management within the healthcare industry across the public and private sector, through to start-ups and multinationals, including WA Health Department Representative for The Australian Organ and Tissue Authority, former Director of Oceanic Medical Imaging, Chair of the Australian and New Zealand Society of Nuclear Medicine Accreditation Board and Vice President of the Australian and New Zealand Society of Nuclear Medicine.

Professional areas of interest include Molecular Oncology and therapy, innovative therapies and research including the development of new techniques. Julie recently established a global network of sites delivering both clinical and research Theranostics including the first FDA approved fluorinated prostate-specific membrane antigen PET scan (F- PSMA; trade name PYLARIFY) and 177Lutetium-PSMA-617 therapy (Lu-PSMA; trade name Pluvicto) for advanced prostate cancer in the US.

Julie is committed to delivering high quality patient care, through evidence-based medicine and research to improve patient outcomes.

John Rockett

Group Director of Quality and Risk

John is the Group Director of Quality and Risk and is a member of the Group Patient Safety Committee within Icon.

In his early career, John practised as a remote area nurse and midwife. He later served in executive nursing roles in North Queensland, as an Honorary Research Advisor at the Faculty of Medicine UQ, and on several Ministerial Committees in Queensland.

John holds postgraduate qualifications in public health, tropical medicine, healthcare management, healthcare quality, patient safety and health information systems. John has been engaged in international health development providing technical consultancy in Australia, China, Asia, the Pacific, the Middle East and Europe.

He has served on the frontline in several theatres of conflict, including Yemen, Kosovo, Mindanao, Timor-Leste, and Bosnia. He is recognised on the Australian Honours List for humanitarian service.

John is supported by the Group Manager of Clinical Quality and Patient Safety, Alison Males, Group Manager of Quality Systems Improvement, Catherine Di Stasi, and Quality SpecialistsAnne Fitzgerald, Caroline Montgomery, Cheree Morgan, Kyla Snelling, and Amanda Waldon.

GROUP PRACTICE UNIT UPDATES

RADIATION THERAPY

GROUP RADIOTHERAPY PRACTICE UNIT (RPU)

The Radiotherapy Practice Unit (RPU) previously only advised Australia cancer division but has evolved to a group level committee with international committee members set to join in 2023.

The RPU has a number of sub-committees that report into it and support governance and the provision of high quality clinical care. The Oncology Information Systems (OIS) change management sub-committee commenced in late 2022, improving the way idea’s for and changes to ARIA and Mosaiq are handled. The Incident Review sub-committee has been operational throughout all of 2022 and has reviewed all radiation oncology related incidents within Icon. 2022 also saw the introduction of a new sub-committee, the Technical SubCommittee (TSC) which oversees all of the technical development, implementation, and project work conducted within cancer care related to radiation oncology.

TECHNOLOGY IMPLEMENTATION

Implementation of technology across the Icon network has been a major focus for the Clinical Care Team. Throughout 2022, a total of 54 clinical releases were provided by the RPU, spanning both new technology within the network or expansion of services within the network.

Within cancer care Australia & New Zealand, there was 47 clinical releases as shown in the graphic below. This included new sites at Concord, Maitland, Noarlunga and Norwest. It also included additional hardware implementations (being either linacs, WoMed KV units, Varian IDENTIFY SGRT systems, or CT scanners) at existing cancer centres at Cairns Liz Plummer, Cairns Private, Gosford, Holmesglen, Moreland, North Lakes, Revesby, Rockingham, Wahroonga, and Windsor Gardens. To support the hardware implementation and growth within South Australia, a new Varian ARIA database was commissioned and implemented as well. The clinical releases also included implementation of established techniques into existing centres including SGRT and stereotactic techniques. Further detail is presented in the table below which is comprised of hardware and additional techniques.

2022 Clinical Releases by discipline (Aus/NZ)

In addition to this, there were also six clinical releases in China including one new site at Sanmenxia, HyperArc for cranial stereotactic radiation therapy at Icon’s cancer centre in Chongqing and in Qingdao, Deep Inspiration Breath Hold (DIBH) breast radiation therapy treatments, as well as motion managed CT sim (4DCT).

To support the new centre at Mt Alvernia hospital in Singapore, another Varian ARIA database was commissioned and implemented. This addition brings the total Icon clinical patient database to nine.

Centre Linac CT scanner WoMed KV SGRT Stereotactic

TRAINING AND EDUCATION

Throughout 2022, the RPU has focused on ensuring all team members have access to documentation required to perform their roles effectively. 2022 saw a large number of new documents published and existing ones enhanced and/or updated. This included:

TECHNICAL STREAMS

The Medical Physics led technical streams, which report into the technical sub-committee of the RPU and are comprised of medical physicists and radiation therapists, have been pivotal in both creating and updating/maintaining processes and systems within their respective technical areas. In 2022, further key enhancement of these streams were made with the inclusion of members from our Icon China team. Team members from Icon ASEAN will join in early 2023.

Below is a brief summary of some of Icon’s technical stream achievements:

107

RADIATION THERAPY (RT) BASED DOCUMENTS 54 CLINICAL COMMISSIONING CERTIFICATES (CCCS) 53

MEDICAL PHYSICS (PHYS) DOCUMENTS

With an additional 38 documents being specifically published for the Icon China team

Imaging and Contouring (Chair: Yunfei Hu)

◊ Publication of eFOV, SEMAR, MRI distortion, and CT annual QA documents

◊ Updates to CT QA procedure and CT commissioning spreadsheets

◊ Ongoing review of all CT and linac based commissioning results as required

Treatment Planning (Chair: Jonathan Lambert)

◊ Publication of training material for medical physics QA checks and Aria upgrade procedures

◊ Setup and testing of Eclipse TPS and Mobius for Icon ASEAN (Singapore)

◊ Preparation and testing for Mobius V4.0 implementation (scheduled for early 2023)

Treatment Delivery (Chairs: Dean Wallace and Adrian Bailey)

STEREOTACTIC RADIATION THERAPY (STER) DOCUMENTS, AND 11

◊ Updates to linac daily QA, linac startup procedures, Elekta frontline maintenance, and patient linac transfer documents (to name a few) and review of several existing documents

◊ Creation of a dedicated Wiki page and Doselab user guide

◊ Ongoing review of Linac commissioning results (6 linac commissionings reviewed)

Halcyon and Adaptive (Chair: Talia Jarema)

◊ Upgraded all Halcyon systems to V3.1

◊ Publication of updated commissioning spreadsheet for Halcyon and Ethos, and a clinical currency procedure

◊ Creation of Litmos training material

Radiation Safety (Chair: James Rijken)

◊ Calculation and review of linac/CT bunker designs, as well as maintenance of survey meter calibrations

To support the release and effective implementation of documentation and new/revised processes, over 25 Litmos training packages were released. These, in addition to the existing courses, were completed over 400 times (Medical Physics staff) for general courses and over 200 times for stereotactic radiation therapy based courses.

The Medical Physics Training, Education, and Assessment Program (TEAP) was also very active supporting Icon’s three TEAP registrars. This included a variety of expert presentations, Q&A sessions, registrar presentations, and individual training sessions. Icon’s TEAP registrars are continually supported by the global Medical Physics team to ensure they are receiving the best possible training and education.

◊ Publication of radiation safety refresher training package

◊ Maintenance of Icon’s Radiation Management Plans and Radiation licences

Dosimetry (Chairs: Virginia Drumm and Bess Sutherland)

◊ Testing and release of V4 of eFilmQA

◊ Oversight of ACDS dosimetry audits

◊ Maintenance of dosimetry standards calibrations

Training and Education (Chair: Ihab Caraguli)

◊ Review and publication of all Litmos training courses

◊ Initiated phase 2 of the Icon Global education project

◊ Provided guidance and material for the revised Medical Physicist CPD requirements from the ACPSEM

Brachytherapy and KV (Chair: Simon Atkins)

◊ Ongoing assistance and review of commissioning for WoMed KV units

◊ Creation and publication of HDR Brachytherapy training course

◊ Publication of 10 new/updated documents related to Brachytherapy and KV

2022 Technical Readiness by anatomical site

Stereotactic (Chair: Ben Archibald-Heeren)

◊ Oversight, review, and support of stereotactic implementation at Icon cancer centres, including review of 27 benchmarking results and technical readiness of numerous stereotactic techniques

◊ Development of new stereotactic techniques including Kidney/Adrenal SBRT

◊ Pilot and implementation of a new stereotactic based audit with audits conducted at 6 cancer centres

Documentation (Chair: Rebecca Murry)

◊ Ongoing management and support of all document requests, creations, reviews, and publication

◊ Oversight of over 200 documents published throughout 2022

◊ Incorporation of oversight of document management for Icon China and Icon ASEAN

Scripting and Automation (Chair: David Jolly)

◊ Formation of the technical stream in September 2022 and holding of inaugural meeting

◊ Incorporation of the scripting working group and subsequent oversight of Varian scripting sprints and scripting releases

In addition to the technical streams, several working groups were active for either new or emerging technologies – including Varian Ethos adaptive RT linacs, Surface Guided Radiation Therapy (SGRT), and scripting. Of the three working groups, only the SGRT working group will continue into 2023, with the Ethos and scripting working groups having been incorporated into the respective technical streams.

2022 working group highlights include:

SGRT working group (Chair: Tai Tran)

◊ Implementation of tattoo-less breast/pelvis treatments at 8 Icon cancer centres

◊ Developed and standardised commissioning for Varian IDENTIFY SGRT systems, as well as publication of several SGRT based documents and Litmos courses

◊ Development of processes for stereotactic radiation therapy utilising SGRT, including cranial SRT/SRS and Lung SBRT

Ethos working group (Chair: Mikel Byrne)

◊ Creation and publication of several documents related to Ethos

Spine (16) Cranial (10) Liver (10)

Prostate (9)

Lung (5)

Kidney/Adrenal (8)

Oligomets (6)

Multi (5) Hybrid Arcs (3)

Advanced Lung (9)

HyperArc (5)

◊ Development of training and competency assessment material for adaptive radiation therapy

◊ Ongoing support for adaptive RT implementation

Scripting working group (Chair: Mikel Byrne)

◊ Ongoing review and prioritisation of script development proposals

◊ Oversight of Varian scripting sprints including updating of all existing scripts to V17/V18 compatibility and creation of script utilisation dashboard, Breast AutoPlan, and automated planning structure scripts

◊ Oversight of all in-house script development and updates including Icon’s image compliance scripts

NURSING GROUP

NURSING PRACTICE UNIT (NPU)

2022 saw the launch of the Nursing Practice Unit (NPU) with membership from the SICC Senior Nurse Leadership Team (SNLT), representatives from the research and quality team, and nurse managers from Icon’s global team. The NPU was established to define, develop, approve, monitor, research, and analyse the standards, policies, competencies, capabilities, and discipline systems required to ensure best practice and to provide the best care for our patients. Legislation, regulation, professional standards, and international best practices guide the NPU in exercising its responsibilities.

In 2022, the NPU has overseen the following initiatives:

◊ Care and Management of Peripheral Intravenous Catheters - Commission Update

Ω Revision of relevant policies and procedures

Ω Revision of Peripheral Cannulation Self-Directed Learning Package (Litmos resource)

Ω Development and implementation of Patient Information Leaflet: ‘Looking after your cannula’

◊ Revision of Care and Management of Venous Access Devices – Update due to increased reports of extravasations:

Ω Revision of relevant policies and procedures

Ω Revision of education and training resources (Litmos)

◊ Implementation of Evusheld: New monoclonal antibody drug therapy for COVID prophylaxis

◊ Totally Implanted Venous Access Device Needles: Global-wide critical shortage

◊ Implementation of Short Duration Infusion of Obinutuzumab

◊ ‘What Matters Most to You’: Patient self-reporting process of individually expressed care needs throughout treatment

◊ Preventing Delirium and Managing Cognitive Impairment NSQHS initiative

◊ Nurse Practitioner PD and scope of practice document development

◊ Group Clinical Practice Policy Nursing Domain

◊ China Nursing Training program development

◊ Nurse Cancer Care Coordinator (CCC) framework

◊ Singapore Radiation Oncology Nursing Procedures

◊ Australian Nursing PD’s incorporating career pathway initiative

◊ New NSQHS Standard

◊ NSQHS Sepsis Clinical Care Standard released by Australian Commission in conjunction with the Acute Anaphylaxis Clinical Care Standard:

◊ Clinical Care Standards working group meetings commenced September

◊ Workflow procedure development for Implementation into Icon clinical practice

◊ Monthly progress reports tabled at NPU by Quality representative

◊ Theranostics Working Group

◊ Pilot North Lakes: access to clinical trials program development

◊ Clinical, Education, Governance support via SNLT representation

TRAINING AND EDUCATION

Throughout 2022, the SICC nursing team have led the following nursing initiatives:

◊ Icon Nurse Graduate Program ‘Beginner to Specialist Cancer Nurse’ – Launch February 2023

◊ Graduate Program being implemented at six centres:

Educational presentations

Administration of Obinutuzumab

Breast Cancer - Radiation Therapy

Care and Management of VAD - update

Cytotoxic Awareness - HK

◊ Education schedule to support Clinical Facilitators and local trainers commenced November 2022 and sessions continuing until program launch

◊ New Icon Nurse Education Team (INET) program: Doctor led radiation oncology nurse education sessions

◊ Development of Patient Handling Program (practical component)/video resource

◊ Development of tumour stream specific patient education brochures – radiation oncology

◊ Medical Oncology/Haematology New Starter Induction Workshops – Attended by 100% of all new starters without experience:

Ω Workshop One Oncology Basics and Extravasation

Ω Workshop Two Antineoplastic Drug Toxicities

Ω Workshop Three Oncology Emergencies

Ω Workshop Four Patient Education and Assessment

◊ Development and implementation of Administration of Antineoplastic Drugs via the Intrathecal Route training program

◊ Design of new Infection Prevention and Control training methodology

◊ Design of ARIA program for nurses – Singapore context

◊ Design of Hand Hygiene Auditor Training Program – China context

◊ Training delivered in phases over several ICC sites in the use of the new Totally Implanted Venous Access Device Needles. Eight sites trained in total.

Cytotoxic Awareness - SG

Extravasation

Extravasation update

Graduate Nurse Program

Infection Prevention and Control

Journal Review

Late effects of Radiation Therapy and Management

Let's Talk About Sex Part 1

Let's Talk About Sex Part 2

Management of Implanted Devices - RT 001-06

Management of antineoplastic drug toxicities

MOH Induction Timetable

Oncological Emergencies

Patient Education and Assessment (3)

Oncological Emergencies (3)

Antineoplastic drug tox. and management (3)

Oncology Basics and Extravasation (3)

Advanced Life Support - Level 1 (3)

Venous Access Device (1)

Back to Basics Radiation: Induce Skin Reactions (3)

How to be an effective trainer (4)

RONKAS Assessor Training (2)

Patient Education and Assessment (3)

Oncological Emergencies (3)

Antineoplastic drug tox. and management (3)

Patient Education and Assessment

Procedure CLIN 002-20 - QA Session

Prostate Cancer - Role of Radiation

Reflective Practice

Role of the Lymphoedema Specialist Nurse

Stem cell Transplant - Basics

Tailoring breakthrough cancer pain treatment choices

Vygon TIVAD Implementation

Zoladex

Chermside South Brisbane Southport Tennyson Townsville Wesley

OTHER HIGHLIGHTS

The SNLT, in conjunction with the wider Icon nursing team, have also been involved in several other initiatives, presentations, and events and have also received group and external industry recognition for their work. A list of the achievements is presented below.

◊ First nurse recipient of the Middleton Scholarship

◊ Queensland Nurse of the Year Finalists

◊ Icon Annual Awards finalists

◊ Cancer Nurses Society of Australia (CNSA) Pre-Congress Workshop – Oral paper presented by Nurse Educator: ‘Late Effects of Radiation Therapy’

◊ Workforce Planning Research collaboration with CNSA/RON SPN (Radiation Oncology Nurses Specialist Practice Network) for future proofing nursing

◊ The RON Research Team are conducting a study looking at Radiation Oncology Facilities and Radiation Oncology Nurse (RON) models of care across Australia with a view to understand RON roles and responsibilities; practice characteristics; explore the needs, concerns and challenges faced by RONs and identify possible opportunities for improvement.

◊ This research is being conducted by SWS Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, South Western Sydney Local Health District in conjunction with (Radiation Oncology Nursing Special Practice Network), CNSA (Cancer Nurses Society of Australia)

◊ Icon radiation sites included in research project

◊ Research outcomes to be published in 2023

◊ Authored ‘Guide on How to Implement a Nurse Navigation Programme for Cancer Patients’ under auspice of City Cancer Challenge (C/Can) and International Society of Nurses in Cancer Care (ISNCC)

◊ Developed, delivered, and evaluated ‘Nurse Navigator Programme’ for Cancer Navigators: Kigali, Rwanda – 10-week education programme

◊ The Union for International Cancer Control (UICC) World Cancer Congress – Panel member for oral presentation ‘Applied Innovation using Wearables to Train Cancer Care Professionals during the COVID pandemic: A Multidisciplinary Perspective’

◊ Chinese Congress of Oncology: Sino-Australia Symposium on Cancer Care – Panel member for oral presentation ‘Applied Innovation – Training Cancer Care Professionals’

◊ Developed and presented ‘Introduction to Cancer for Hospital-Based Inpatient Facilities’ –Mount Alvernia Hospital, Singapore

◊ Subject coordinator – Graduate Certificate in Cancer Nursing – University of Melbourne

◊ National Implementation NSQHS Accreditation clinical standards

◊ Development Supportive Policy and Procedure pertaining to ACHS recommendations

◊ Founders Forum Representation: project Global Workforce Sustainability (Nursing Focus)

◊ Partnerships: MoU Leukaemia Foundation

◊ Partnerships with 12 universities: CQ University, Avondale University (Sydney), Griffith University (Brisbane/Gold Coast), James Cook University, QUT, University of SA, University of Southern QLD (USQ), University of Sunshine Coast, University of Canberra, University of Sydney, University of Tasmania (UTAS)

◊ Future partnership negotiations scheduled for 2023 with expanded national university partnerships including ACU and Deakin

PROJECT UPDATES

Noona:

Icon has been collaborating with Varian and has commenced piloting the new patient reported outcomes tool, Noona. A radiation oncology pilot commenced in November 2022 at Icon’s cancer centres in Richmond and Freemasons.

The pilot will be completed in Mid-February 2023, followed by a stringent metric analysis to validate the product and inform next steps. The results of this pilot will inform the appropriate operating model for Noona's national implementation.

Survivorship Program:

The Survivorship project plan was signed off by the CEO – Cancer Services (AU & NZ) on 28 June 2022. The first Survivorship SteerCo was held in July 2022, and weekly meetings held throughout the year. The pilot will commence in February 2023.

Key project achievements:

◊ Survivorship model of care defined

◊ Tumour streams for inclusion in pilot defined

◊ Patient inclusion and exclusion criteria, and risk rating documented

◊ Resourcing agreed - Cancer Care Coordinators or Survivorship nurses to deliver the program

◊ Pilot sites defined: Concord, Gold Coast Private, Southport, Maroochydore and Warrnambool

◊ Survivorship Pathway designed in ARIA to provide automated solution for RO sites

◊ Survivorship pathway mapped out for MO/day hospital sites

◊ Wellness Care Plan templates developed

◊ Assessment criteria pilot program defined

◊ Data capture designed via Power BI

◊ Pharma funding source identified for pilot (subject to formal agreement)

MOLECULAR ONCOLOGY

GROUP MOLECULAR ONCOLOGY PRACTICE UNIT (MOPU)

Expansion of Icon Group’s cancer care provision includes theranostics as a new treatment option for patients, which is expected to be a significant future growth area in oncology. The establishment of a theranostics research program in parallel to the development of clinical services to increase patient access to clinical trials is included in the strategy.

The Molecular Oncology Practice Unit (MOPU) was formed in September 2022 to support the molecular oncology strategy to initially include theranostics, interventional oncology, and radiopharmacy. The membership of the MOPU includes representatives from Quality and Risk, Research, Nursing, Pharmacy, Medical Physics, and Nuclear Medicine, providing a broad scope of expertise.

The initial focus for the MOPU is the development of a clinical governance framework for theranostics. To date, the following documentation has been published:

◊ TOR 027 Molecular Oncology Practice Unit Committee

◊ MRT001 PSMA Consent form

◊ MRT005 Prostate Cancer Questionnaire

◊ MOLT 001-02 Radionuclide Therapy Nursing Procedure

◊ MOLT 001-04 Radionuclide Therapy Extravasation Procedure

◊ MOLT 001-05 Clinical Protocol Lu-177 PSMA

◊ PHYS 005-11 Radiation Management Plan Radionuclide Therapy

◊ Radiation Management Plan Nuclear Medicine and PET-CT Centre Singapore

TRAINING AND EDUCATION

The Clinical Care team would like to thank the members of the Nurse Working Group who have been instrumental in developing nursing policies and procedures to support the theranostics clinical service. The group are creating a Theranostics Nursing Competency Assessment Tool to support nurse education within this new clinical service that will be offered to patients in early 2023. Members of the group include:

JADE FITZGERALD

NURSE EDUCATOR, STRATEGIC INVESTMENT AND CLINICAL CARE

COLLEEN GEDDES

NURSE UNIT MANAGER, ICON CANCER CENTRE NORTH LAKES

CHANTELLE LITWIN

REGISTERED NURSE, ICON CANCER CENTRE MAITLAND

SEAN PASKINS

NURSE MANAGER, ICON CANCER CENTRE MAROOCHYDORE

DANNI STEELE

ASSOCIATE DIRECTOR OF NURSING – CLINICAL, STRATEGIC INVESTMENT AND CLINICAL CARE

OTHER HIGHLIGHTS

ARIA

A care pathway (Carepath) in ARIA has been developed for theranostics to support the clinical workflow. This includes the ability to capture patient information into discrete fields, allowing the review of patient outcomes and improving patient care.

North Lakes

North Lakes in Brisbane will be Icon Group’s first centre to offer a theranostics service. The centre has the infrastructure and resources to support both a clinical service and provide patients with access to clinical trials. The service is expected to treat their first patient in March 2023.

Singapore

A major focus for 2022 was the start-up of Icon Nuclear Medicine and PET-CT, part of the new Icon Cancer Centre located at Mount Alvernia Hospital in Singapore. The Icon teams in Singapore and Australia have developed PET-CT documentation and ARIA workflows to achieve regulatory approval from the National Environment Agency and Ministry of Health. The team will scan the first patient in early 2023.

Research and clinical trials

Icon in Adelaide has been selected as the lead private site for Telix Solid Tumours Phase 1B study with CRO Novotech. This is a phase 1b Dose Escalation/Expansion study of the combination of 177Lu-TLX250 and peposertib in patients with carbonic anhydrase IX (CAIX)-expressing solid tumors.

Icon Singapore have submitted feasibility questionnaire for two Novartis trials:

Novartis phase 111 AAA603D1230 breast trial, a study of [177Lu]Lu-NeoB in combination with capecitabine versus capecitabine alone for the treatment of post-menopausal women with hormonal receptor-positive, human epidermal growth receptor-2 negative metastatic breast cancer after progression on previous endocrine therapy in combination with a CDK4/6 inhibitor.

Novartis phase 111 CAAA603E1230 glioblastoma trial, a study of [177Lu]Lu-NeoB versus Lomustine for the treatment of Recurrent Glioblastoma.

The oncology segment market for theranostics is expected to grow to an excess of 120 billion by 2025, providing a significant pipeline of industry funded clinical trials. Icon have been approached by many Pharma companies who are interested in partnering with Icon to deliver theranostics clinical trials which will be possible at Icon sites once North Lakes and Mount Alvernia are operational.

MEDICAL PHYSICS

ANNUAL STATISTICS AND DATA

2022 saw the Icon medical physics team shift to a global model with overarching leadership from the Group Director of Medical Physics, Trent Aland, and Assistant Group Director of Medical Physics, Anthony Walsh. This evolution also saw the introduction of a Regional Medical Physics Manager for Icon China, Kellwen Hu. The global medical physics team consists of 51 team members across Australia and New Zealand, six team members in Mainland China, and one team member in Singapore.

Supporting patient treatments is at the core of the medical physics team. This year, over 55,000 ARIA tasks were completed by the team within Australia and New Zealand, over 4,700 Mosaiq tasks were completed within Australia, and over 5,300 ARIA tasks were completed in Icon China. In total, the global medical physics team interacted with and impacted over 15,600 patients.

Medical Physics Activity (Jan - Nov 2022)

Queensland (21326)

Victoria (12575)

New South Wales (4945)

Western Australia (3033)

Tasmania (2499)

Australian Captial Territory (1744)

New Zealand (1314)

ICON AUS/NZ ARIA ACTIVITY

Queensland (4019)

South Australia (754)

ICON AUS/NZ MOSAIQ ACTIVITY

Chongqing (846)

Qingdao (837)

Fengcheng (800)

Sanmenxia (793)

Jiangxian (716)

ICON CHINA ARIA ACTIVITY

Of this activity, more than 4,200 ARIA tasks within Australia and New Zealand were solely for stereotactic techniques.

Icon Aus/NZ Aria Stereotatic Activity - Medical Physics (Jan - Nov 2022)

PUBLICATIONS AND PRESENTATIONS

Throughout 2022, three peer reviewed journal articles were published, complemented by three poster presentations at national conferences and seven oral presentations. These publications showcase the talent, expertise and quality of work across the group.

◊ S Barr, D Mulherin, A Walsh, and M Spalding. Investigation of dose profile across the junction of deep inspiration breath hold, breast with supra-clavicle fossa treatments. 2022. Med. Dosim., 47(3): 227-35

◊ M Byrne, B Archibald-Heeren, Y Hu, P Greer, S Luo, and T Aland. Assessment of semi-automated stereotactic treatment planning for online adaptive radiotherapy in Ethos. 2022. Med. Dosim., 47(4): 342-47

◊ Hu, M Arnesen, and T Aland. Characterisation of an advanced cone beam CT (CBCT) reconstruction algorithm used for dose calculation on Varian Halcyon linear accelerators. 2022. Biomed. Phys. Eng. Express, 8(2): 025023

◊ ACPSEM webinar: Ethos and Adaptive Radiotherapy (MIRSIG), Oral presentation by Ben Archibald-Heeren.

◊ Varian webinar: Clinical implementation of IDENTIFY across the Icon network, Oral presentation by Nigel Middlebrook & Dean Robb.

◊ EPSM conference: The need for individualised breathing trace quality assurance for lung patients undergoing 4DCT simulation, Oral presentation by James Rijken.

◊ EPSM conference: Evaluation of set-up accuracy for a large cohort of radiotherapy patients positioned with SGRT-only without the aid of skin-marks at a single institution, Oral presentation by Mantaj Sekhon.

◊ AOCMP conference: iCBCT algorithm for dose calculation on Halcyon linacs, Oral presentation by Yunfei Hu.

◊ Varian presentation, PUMCH China: Ethos Adaptive Technical Overview, Oral presentation by Mike Byrne.

◊ Varian presentation, Mount Sinai ART seminar: Ethos Adaptive Radiotherapy: Early Literature and Clinical Implementation, Oral presentation by Ben Archibald-Heeren.

◊ COGNO Annual Scientific Meeting: Implementation of Identify Surface Guidance for Intracranial Stereotactic Radiosurgery (SRS), Poster presentation by Tai Tran, Ben Archibald-Heeren, Dr Cecelia De Gzell.

The team were also involved in an internal medical physics audit program to ensure all Icon cancer centres were adhering to best practice and in line with Icon Group’s quality standards. Throughout 2022, a total of 33 medical physics audits were completed across Australia and New Zealand which was complemented by 24 independent dosimetry audits.

These audits will be implemented into Icon China and Icon ASEAN in early 2023.

In addition to the many global projects and clinical releases, the team were also involved in several medical physics specific projects ranging from the creation of training courses for stereotactic radiation therapy and TrueBeam linacs, to 3D printer commissionings, to standardisation of CT scanner scanning parameters, to an initial implementation of a QA management system.

Specifically within Icon China, extensive work has been done in setting up a medical physics SharePoint page similar to what exists within Australia and New Zealand. The team also completed redrafting control documentation and spreadsheet templates for use by the medical physics team based in Icon China. This work will also continue in 2023.

◊ EPSM conference: Portal Dosimetry (PDIP) for patient specific QA of Varian Hyper-arc Multi-met SRT, Poster presentation by Dean Wallace.

◊ EPSM conference: A Multi-department analysis of traditional Winston Lutz measurements vs MPC on a Varian Truebeam Linac, Poster presentation by Dean Wallace.

◊ World Cancer Congress: Quality Implementation of Stereotactic Radiotherapy Services across an International Network, E-Abstract by Trent Aland, Nola Bailey, Lee Anderson, Kelvin Hiscoke, Rhys Fitzgerald, Dr Marcel Knesl, Dr Andrew Fong, and A/Prof Matt Foote.

COLLABORATIONS

The Icon medical physics team lead a large number of collaboration projects with our equipment vendors, which are supported by the medical physics team as well as the SICC RT team. 2022 saw the completion of four collaborations as well as the activation of the Varian HyperArc registry (an initiative led by the research team and part of Icon and Varian’s research agreement). In addition to this, there are two further collaborations in progress and a number in development.

Title Detail

Halcyon LiveView Motion management solution for Halcyon Yunfei Hu, Sam Towns COMPLETED

AIRC segmentation Testing of AIRC AI contouring product Yunfei Hu, Tom Chen COMPLETED

Ethos Prostate / H&N Multi-Centre development of Prostate and Head&Neck white papers

Mikel Byrne, Ben Archibald-Heeren COMPLETED

Qumulate Testing and development work for Qumulate Dean Wallace COMPLETED

M-QA SOW Automated linac QA

Dean Wallace IN PROGRESS

EDUCATION

In a joint initiative with both the SICC RT team and Brisbane State High School (BSHS), Anthony Walsh and Trent Aland were privileged to speak with students of the BSHS Medicus program about a career in radiation oncology. The session was well attended and will be followed-up with a practical session in early 2023.

Internationally, there has been a steady progression of staff in both Icon China and Icon ASEAN completing the medical physics based Litmos courses for general medical physics work as well as advanced techniques including stereotactic. Staff upskilling will continue to be a focus for 2023.

Ethos margin reduction

Technical study reviewing past patient data to determine margin reduction potential

Mikel Byrne IN PROGRESS

Medical Physics Leads Status

RADIATION THERAPY AND ICON PLAN

ANNUAL STATISTICS AND DATA

This year the remote stereotactic support program was revised and as a result the cancer division have been accessing a greater amount of stereotactic support, enabling patients to receive safe, high quality stereotactic treatments close to home and further allowing centre based staff to deliver these techniques with confidence. 2022 saw over 1,100 support sessions being provided by the SICC RT team.

2022 Stereotactic support sessions - SICC RT

Icon Plan also had a very busy 2022 delivering record numbers of plans across the group’s global cancer centres. In total, over 2,700 treatment plans were developed with a record 390 of those being produced in November alone.

2022 Stereotactic plans created - SICC Icon Plan

PUBLICATIONS AND PRESENTATIONS

◊ Varian Oncology Summit: Clinical Use of Multi-criteria Optimisation, Oral presentation by Ashley Harwood

◊ Varian Oncology Summit: Halcyon Stereotactic Planning. Oral presentation by Huong Nguyen

◊ SMIRT conference: Staying Connected- Onboarding for a remote environment, Oral presentation by Charlotte Skidmore

◊ NZIMRT conference: Remote Clinical Training for RTTs in China, Oral presentation by Aidan Leong

◊ NZIMRT conference: Case Study on use of SABR for a Patient with Oligometastatic Disease, Oral presentation by Aidan Leong. NOTE: Aidan also received the Best RT presentation and People’s ChoiceRT awards at this event

◊ World Cancer Congress: Applied innovation using wearables in training Cancer Care professionals remotely during the Covid Pandemic, Panel discussion including Aidan Leong.

◊ Chinese Congress on Oncology (COO): Applied Innovation Training Cancer Care Professionals, Panel discussion including Aidan Leong.

EDUCATION

This year marked an extension of in-house education to promote educational and professional development opportunities for Icon RTs. A newly formed Planning Overview Workshop Education RTs (POWER) allows for RTs across the network to present on advanced planning techniques to promote best practice. In 2022 there were eight POWER sessions covering interesting cases that have provided interactive learning and a platform for clinical discussions. It was encouraging to see on average more than 50 RT’s attend each live session. This will continue to evolve in 2023 with a successful uptake and positive feedback on the value of education and knowledge sharing across sites.

In addition to the POWER sessions, several in-services were held throughout the year. Inservices provide internal and external stakeholders to present on up-to-date information on technologies and practices. Our collaboration with Varian and Siemens Healthineers has seen an in-service presented on AI in the future of cancer imaging and a planned in-service for early 2023 on HyperSight.

Throughout the year, planning courses have been offered for RTs to consolidate their skills in head & neck and pelvis planning. These planning courses are supported by Icon Plan staff to upskill RTs utilising plan evaluation workbooks to promote independent learning. 28 RTs across the network successfully completed these courses in 2022. 2023 will see the introcution of lung and breast planning courses.

Throughout the year there has been continual support of onboarding and training of new RTs across Concord, Noarlunga and Norwest as well as supporting implementation of new technologies at Gosford, Holmesglen, Wahroonga, and Windsor Gardens.

Internationally, SICC RT staff have been supporting the setup of Icon’s first radiation oncology clinic in Singapore, at Mt Alvernia Hospital, as well as the fifth radiation oncology clinic in Mainland China, in Sanmenxia. This also represented a significant collaborative effort with established Icon China sites Chongqing and Qingdao both hosting staff from Sanmenxia during their onboarding periods. Following on from this, three Icon China RTT’s are now credentialled to deliver training locally and are successfully delivering the Icon training program and staff assessment to achieve competency in Icon processes.

2022 also saw the implementation of stereotactic radiation therapy at Icon China Chongqing and Qingdao. Staff at both clinics completed training requirements for the successful release of HyperArc for the treatment of patients with multiple intracranial metastases.

A highlight of the year was the involvement of Icon SICC RT staff, Huong Nguyen and Nathan Mauro, in delivering multiple education sessions to students of the Brisbane State High School Medicus program, sharing insights into a career in radiation oncology. This was joint initiative with the SICC Medical Physics team.

QUALITY AND RISK INTRODUCTION

The Group Quality and Risk team have clinical governance accountabilities across Australia, New Zealand, Singapore, Hong Kong and Mainland China that include:

◊ Designing, implementing, supporting, monitoring, and evaluating a global clinical governance framework

◊ Guiding, monitoring, and evaluating the clinical governance committees

◊ Developing strategies and systems for the safety of patients, carers, and staff

◊ Design systems for quality, performance, and reduced risk in clinical care

◊ Monitoring and supporting the conduct of accreditation, audits, and reviews

◊ Tracking regulatory licensing compliance and licencing requirements

◊ Advising on and supporting operational quality research

◊ Promoting openness and reflective practice

◊ Assuring good management of incidents and risks through a continuous improvement cycle approach

The Group Executive established the Group Patient Safety Committee (GPSC) as a part of the Clinical Governance Framework in January 2022. The Committee governs the processes in developing clinical policies and procedures, coordinates accreditation and audit, ensures interdisciplinary collaboration and communication, oversees the applicability of pertinent healthcare legislation, regulation, and standards, defines clinical quality reporting requirements, and sets clinical performance metrics. The GPSC will be supported by Regional Patient Safety Committees as required.

The GPSC governs patient safety and healthcare quality across Icon's Australian locations and supports the governance of patient safety and quality programs in other non-Australian sites in conjunction with the Regional Patient Safety Committees as required.

ANNUAL STATISTICS AND DATA

Group Patient Safety Committee (GPSC)

Eleven GPSC meetings were held over the year with Group Directors, country representatives, and Medical Directors. Since its inception, the GPSC has noted 31 actions, of which 19 are closed. The origin of the actions are from multiple sources as outlined below:

2022 GPSC Actions

The transition to the Clinical Governance Framework has seen the implementation of several additional Practice Units to govern clinical care areas. These include the formation of the following:

Accreditation

In July 2023, the Australian Commission will introduce the Short Notice Assessment Pathway (SNAP) for centres that undergo accreditation in Australia. SNAP will give health services 48 hours of notice of an organisation-wide survey. SNAP varies from the current program, which is planned well in advance. The Quality Specialists within the Quality and Risk team are developing a program to support sites with the changes to this assessment form. The program will include training sessions, resources and ongoing monitoring of sites to the standards.

The Australian Commission has commenced the integration of a National Clinical Trials Governance Framework in its assessment of sites that undertake clinical trials. A gap analysis has been conducted to determine key focus areas for the Research team. The Quality and Risk team and Research team have identified opportunities to integrate Research into existing governance processes. Assessment of health services against the new framework will commence from 2023 on a growing maturity scale before full implementation into the organisation-wide assessment.

Accreditation achievements

AUSTRALIAN COMMISSION

Accreditation allows Icon to demonstrate to an external body how we operate to a set of standards determined by the Australian Commission. In 2022, there were four interim accreditations and one organisation-wide survey spanning 13 sites in Australia. These surveys were successful due to the combined efforts of on-site clinical teams, Practice Units and the Quality and Risk team. The surveys resulted in 19 recommendations that must be implemented by the next survey cycle.

NATIONAL ASSOCIATION OF TESTING AUTHORITIES

Icon’s cancer centres undertaking apheresis must undergo accreditation with the National Association of Testing Authorities Nata. South Brisbane and Wesley centres received accreditation to laboratory standards in June. Some minor recommendations were rectified.

ACHS INTERNATIONAL

Icon centres in Singapore have accreditation membership with ACHS International, which is voluntary. The yearly check-in with a Focused Advisory Checkpoint (FAC) has resolved two recommendations identified at the organisation-wide survey in 2020. The Singapore team have implanted these processes into their monitoring, evaluation and governance, demonstrated to the assessor in December.

Regional Patient Safety Committees have been implemented in the ASEAN portfolio (governing Singapore and Hong Kong) and in Mainland China. These committees are the conduit for the Group Patient Safety Committee and ensure practice monitoring in each region.

Licencing

A quality improvement was identified to provide clear accountabilities and responsibilities to the licenses held by the facility, and inconsistencies were identified between states and countries. An amalgamation of document repositories and a register was completed, introducing a new site utilising Microsoft SharePoint.

The site was published in October and has effectively been able to inform nominated persons of upcoming license renewals and track renewals over time through an interactive dashboard.

The Quality and Risk team supported the licensing of new Icon Cancer Centres in 2022, including:

◊ Icon Cancer Centre Concord (Australia)

◊ Icon Cancer Centre Central Building (Hong Kong)

◊ Icon Cancer Centre H Zentre (Hong Kong)

◊ Icon Cancer Centre Norwest (Australia)

◊ Icon Cancer Centre Mt Alvernia (Singapore)

◊ Icon Cancer Centre Windsor Gardens (Australia)

Clinical Audits

The clinical audit program has matured over the year with a detailed review of clinical audits trending over time. The information is presented to the governing practice unit, where recommendations and improvements are made. Figure 1 demonstrates the marked improvement in audit compliance over the last six months.

Hong Kong centres have had audits scheduled throughout the year and will commence a formalised audit program in 2023, with future results to be reported.

Over the last 12 months, over 200 quality improvements have been identified through the auditing process, with over 350 quality improvements recorded. This demonstrates the value of the auditing process to improve clinical care across our centres. The Quality and Risk team’s role is to identify themes throughout these audits across multiple sites and implement more broadly spread recommendations.

This year was the launch of the first Icon Group Hand Hygiene report, which integrates all systems that collect hand hygiene information into one dashboard (Figure 2).  As shown, audit compliance across all centres for 2022 was 90%, which is much higher than the accepted benchmark of 80%.

Figure 1 Clinical Audit compliance results from Q2 2022 and Q3 2022

Figure 2 Hand Hygiene Dashboard

Incident Management Reporting

Improvements to clinical incident reporting have enabled the identification of patient safety goals, targets for zero avoidable harm and identification of the level of harm rating accuracy for medication reaction events.

Planned reporting improvements include shared PowerBI reports with filter capabilities for sites, professional roles, and clinical practice committees. An example of the metrics now being reported in shown in Figure 3.

Document Management System

The Quality and Risk team upgraded the Document Review Centre to ensure better usability and support controlled document review processes. A document management working group was established to identify how controlled documents are managed within the organisation. Following the document management system upgrade and reporting oversight, the efficiency of document review has seen an increase in the timeliness of documents moving to the publishing stage.

Upgrade improvements include:

◊ Allocation of a document owner (Director or Executive)

◊ Assignment of a Responsible Committee

◊ Alerts to Document controller to identify documents ready for publication.

◊ Clarification of the controlled document process and the documents that are classified as controlled

◊ Reporting ability for Directors to quickly identify documents under review and approval status.

A Document Review Centre Dashboard has been developed (See Figure 4).

Figure 3 Clinical Incident Management Dashboard

Figure 4 Document Review Centre Dashboard

PUBLICATIONS AND PRESENTATIONS

Group Clinical Governance Framework

In 2022, the Quality and Risk team produced Icon's Clinical Governance Framework. This document defines accountabilities and structures for the design, delivery, and evaluation of care. The Framework contextualises clinical governance as an integrated component and corporate governance, prescribes elements based on international standards, and promotes a culture of quality in supporting good clinical governance. Also, the document describes the roles and responsibilities of an essential partnership between patients and consumers, clinicians, managers, and governing instruments in implementing an effective clinical governance system. Through these structures and processes, individual and group accountability for the design, delivery, monitoring and evaluation of safe clinical services and quality of care is clearly defined.

The Framework consists of seven broad areas or domains that reflect a 'systems model' and have alignment with the World Health Organization's Global patient safety action plan 2021–2030, capturing our commitment to clinical excellence and supporting our business model where business and healthcare partnerships are essential:

DOMAIN 1: CLINICAL GOVERNANCE AND A CULTURE OF QUALITY

DOMAIN 2: HEALTHCARE WORKFORCE

DOMAIN 3: CLINICAL ENVIRONMENT AND RESOURCES

DOMAIN 4: CLINICAL PRACTICE

DOMAIN 5: HEALTHCARE SERVICE PARTNERSHIPS

DOMAIN 6: PATIENT-CENTREDNESS

DOMAIN 7: CLINICAL EFFECTIVENESS

Group Patient Safety Goals

The Icon Group Patient Safety Goals represent the key clinical performance indicators for benchmarking patient safety in all healthcare settings. To ensure healthcare facilities focus on preventing major sources of patient harm, the Group Patient Safety Committee will regularly review and, where required, revise our goals to ensure the targeting of major patient safety issues. Our major focus areas include radiation safety, preventing infections, medication errors, and specific clinical harms such as falls and extravasation.

The three patient safety goals are:

GOAL 1 – PATIENT SAFETY

That people receive their healthcare without experiencing preventable harm

GOAL 2 – APPROPRIATE CARE

That people receive appropriate, evidence-based care

GOAL 3 – CONSUMER PARTNERSHIP

That there are effective partnerships between consumers and healthcare providers, and organisations at all levels of healthcare provision, planning and evaluation

ICON GROUP

Level 1, 22 Cordelia Street

South Brisbane QLD 4101

Australia

T +61 7 3737 4500

icongroup.global