ANNUAL REPORT 2015-16
THE VISION FOR THE VICTORIAN COMPREHENSIVE CANCER CENTRE (VCCC) IS TO SAVE LIVES THROUGH THE INTEGRATION OF CANCER RESEARCH, EDUCATION AND PATIENT CARE. THROUGH INNOVATION AND COLLABORATION, THE VCCC, IN CONJUNCTION WITH OTHERS, WILL DRIVE THE NEXT GENERATION OF IMPROVEMENTS IN THE PREVENTION, DETECTION AND TREATMENT OF CANCER.
The Victorian Comprehensive Cancer Centre, a joint venture between: The Victorian Comprehensive Cancer Centre, a joint venture between:
victorianccc.org.au
victorianccc.org.au
Cover, pages 1, 6 and 21: The Victorian Comprehensive Cancer Centre’s welcome hall and atrium. Images: Peter Bennetts.
CONTENTS Chairperson’s report
2
Executive director’s report
3
VCCC building project
5
Welcome - Murdoch Childrens Research Institute
7
VCCC program updates
8
Financial Statements
21
Declaration by the manager of joint venture
23
Review of operations
24
Committee members
25
Board members
26
Comprehensive operating statement
27
Balance sheet
28
Statement of changes in equity
29
Cash flow statement
30
Independent auditor’s report
31
VCCC ANNUAL REPORT 2015-16 | 1
CHAIRPERSON’S REPORT This year has seen a culmination of many years of planning and collaboration. A substantial part of our collaborative partnership has now been co-located in the Parkville medical and research precinct with the completion and opening of the VCCC Building with links to our other partners across Melbourne also further developed.
“Our clear aim is to accelerate the improvement of cancer results and lift the burden of cancer, improving the lives of many patients and their families.”
This achievement marks years of dedication by staff and volunteers who have given their time and experience so that we can begin to transform the way we research, teach and treat cancer. The building will now be a catalyst to re-double our efforts to provide benefit across our wide partnership. Our clear aim is to accelerate the improvement of cancer results and lift the burden of cancer, improving the lives of many patients and their families. I would like to add my special thanks to the previous Chair, VCCC Board, Professor Richard Larkins. His leadership and wisdom were essential in the formative years of the VCCC and our collaborative partnership is indebted to his work to establish the vision for the VCCC. This year the Murdoch Children’s Research Institute joined the VCCC partnership taking us to 10 member organisations. This partnership of successful service, research and teaching organisations has provided the depth of expertise and breadth of program to realise the aspiration for a comprehensive cancer centre amongst the best internationally. It provides the opportunity to influence and improve patient care driven by new research evidence, across a large area of Melbourne with our collaborations extending further throughout the state, nationally and internationally. The VCCC partnership has been re-funded by the Victorian Government for a further four years. We sincerely thank the Premier, Ministers and cabinet for their vision and support to fully develop the VCCC and the successful comprehensive cancer centre model by continuing their investment in our work. I would also like to acknowledge the enormous contributions of Professor Jim Bishop AO, our inaugural Executive Director of the VCCC Ltd. Jim has provided outstanding leadership in helping to build the VCCC alliance and facilitate the development of new clinical and research facilities. Jim has signalled his wish to step down at the end of December 2016, having now positioned the VCCC for an exciting next stage of development. Professor Bishop’s commitment to reducing the burden of cancer has anchored his work and enabled him to build research links, mobilise talent and energise the community toward common goals. We thank Jim sincerely for his contributions and know he will remain a friend and supporter of the VCCC. Finally, we thank the public, our patients and their families for providing the inspiration to develop this important program.
Professor Linda Kristjanson Chairperson, Victorian Comprehensive Cancer Centre
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EXECUTIVE DIRECTOR’S REPORT The VCCC partnership has for the last few years been a program and a collaboration under construction. The completion of the new VCCC building and the beginning of a new funding agreement provides renewed focus for the VCCC. Over the next four years the VCCC has the opportunity to build strongly on the work of its foundation years. Over the last year the VCCC partnership has grown to ten partners, with the addition of the Murdoch Childrens Research Institute. The expansion of partners over recent years has been quite strategic aimed to align the VCCC partnership with partners of the Melbourne Academic Centre for Health and institutions affiliated with the University of Melbourne. This partnership provides access to large cancer patient populations, enables the further development of clinical research and clinical trials, deepens cancer research and education capabilities and will enable wider impact on more patients for improvement in cancer results. The VCCC partnership’s strategy for building a centre of excellence has been to expand the cancer research capabilities of our partners and develop new methods for more rapidly translating research discoveries into routine clinical practice. The VCCC partnership’s research strategy has been to identify our cancer research strengths and key gaps, measure and benchmark our research performance, invest in the very best researchers, build innovative shared research platforms and build translational research structures and opportunities.
“The VCCC partnership’s strategy for building a centre of excellence has been to expand the cancer research capabilities of our partners and develop new methods for more rapidly translating research discoveries into routine clinical practice.”
The VCCC completed its third global analysis of cancer publications, which compared VCCC with 72 other cancer centres around the world. This provided details on the depth and impact of the VCCC research program. It also established the VCCC’s world ranking against other cancer centres based on research impact (26th out of 73) and identified areas of strength and weakness that will be a focus for further research development. The Leaders in Cancer Research Program has been the VCCC partnership’s vehicle to recruit and retain the very best researchers, clinicians and teachers. It has built new research programs in priority areas with recent appointments in nursing research, palliative medicine and genomics. Further recruitment of research leaders is underway in surgical oncology, psycho-oncology, bioinformatics and gynaecological cancers. These appointments provide a magnet for other talented cancer researchers. The Tumour Stream Leads pilot program is aimed at developing and translating new research directly into clinical practice and expanding research opportunities more quickly. Research and Education Leads were appointed for melanoma & skin cancer and haematology, and primary care. The appointment of Research and Education Leads for three further tumour streams/themes is currently underway, including for nursing, lung and gastrointestinal cancers. The VCCC’s Molecular Tumour Board has continued to drive the translation of genomics information for personalised medicine into improved clinical treatment.
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The VCCC partners have instigated a number of important collaborative initiatives this year including joint funding applications for platform technologies and collaborative research programs. New funding has been secured from the Australian Cancer Research Foundation for a Breakthrough Technologies Laboratory (at the Walter and Eliza Hall Institute of Medical Research, $2.5 million) and a Translational Proteomics Facility (University of Melbourne, $2 million), refunding of the Cancer Therapeutics CRC ($34 million) and new funding for the Australian Genomics Health Alliance (led by the Murdoch Childrens Research Institute, $25 million). The VCCC partnership has supported the development of the Research Excellence (REx) initiative, successfully led by Melbourne Health, to streamline and harmonise ethics review systems for multicentre clinical research and clinical trials across the ‘Parkville and Partners’ group. This will enhance the ability of the VCCC partners to lead more high-priority, high-impact cancer clinical trials, a key feature of comprehensive cancer centres. The VCCC partnership has made education and training a cornerstone in building a centre of excellence. The focus has been skills-training for key clinicians and researchers in leadership roles in partnership with the Melbourne Business School, laboratory team leaders (with Marlow Hampshire) and clinical teachers (with the Excellence in Clinical Education team in the Melbourne Medical School) providing training to 60 people across the VCCC. The VCCC partnership has sponsored or organised over 20 cancer-related conferences, symposia and workshops. These are aimed to enhance the sharing of knowledge, experience and research outcomes and to build further research collaborations. The VCCC partnership has continued its support for annual Psycho-Oncology Research Conferences, following the inaugural event in 2013. The Living with Cancer Program has been the VCCC partnership’s initiative over this last year to improve the outcomes and experiences of cancer patients. The VCCC partnership completed its first clinical audit, in lung cancer. In 2016, the VCCC conducted a second Cancer Patient Experience Survey (CPES) across the expanded VCCC partnership, with data collected for over 3,500 patients. In addition, three clinical improvement implementation projects based on findings from the first CPES in 2013 were completed in 2016, all focussed on improving provision of timely and specific information to cancer patients. During 2015, the VCCC Board led the development of a new Strategic Plan for 2016-2020. This documents our achievements from our establishment and presents priority areas for activities for the VCCC partners to work on.
Conclusion Since its foundation in December 2009, the VCCC partnership has developed and delivered a strategic program of key initiatives. These have built solid foundations and proof-of-concept projects with a focus on developing the collaborative culture between our partner organisations. This work provides a good basis for the future success of the VCCC. The achievements of the VCCC partnership over the last year are extensive, and are already bringing real benefits to patients and to Victoria.
Professor Jim Bishop AO Executive Director, Victorian Comprehensive Cancer Centre 4 | VCCC ANNUAL REPORT 2015-16
VCCC BUILDING PROJECT
The Victorian Comprehensive Cancer Centre (VCCC) Project has delivered a $1 billion facility purpose-built for cancer research, treatment, care and education in the Melbourne suburb of Parkville, Victoria. The project was jointly funded by the Federal Government and State Government of Victoria. On July 17th, 2016, Victorian Premier Daniel Andrews, Victorian Minister for Health Jill Hennessy and Commonwealth Minister for Health Sussan Ley opened the world-class centre that will drive future innovations in cancer research, treatment, care and education. The official opening coincided with a visit from Joseph R Biden Jr, the Vice President of the United States of America who toured the facility. To mark the historic occasion, an agreement was signed that will see Victoria and USA join forces in the fight against cancer and work together on ground-breaking research to find a cure and save lives. This Memorandum of Understanding (MOU) between the USA’s National Cancer Institute and Victoria will strengthen international ties and encourage greater cooperation and sharing of knowledge in cancer research and patient care. As part of this MOU to share information on cancer research, prevention, control and management, the Victorian Cancer Agency will establish a new Victorian USA Cancer Fellowship Exchange Program. The program will support the exchange of up to four senior researchers a year between Victoria and National Cancer Institute sites in the USA to undertake research in cancer for between six to 12 months. This sharing of knowledge will further enhance Victoria’s expertise in translational cancer research and build upon our reputation as a world leader in health and medical research.
Top: Premier of Victoria The Hon. Daniel Andrews MP with the Victorian Minister for Health The Hon. Jill Hennessy and the Commonwealth Minister for Health The Hon. Sussan Ley. Above: Prof. Sean M. Grimmond B.Sc. Ph.D. FFS (RCPA) Director & The Bertalli Chair in Cancer Medicine The University of Melbourne Centre for Cancer Research Victorian Comprehensive Cancer Centre, with Vice President of the United States of America, Joseph R Biden Jr.
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Mr Biden, whose son died of brain cancer, is renowned for his passion for improving cancer care through research. He is leading the USA’s National Cancer Moonshot Initiative to cure cancer, launched earlier this year by President Barack Obama. The initiative aims to make a decade of progress in preventing, diagnosing and treating cancer in five years, ultimately striving to end cancer. As chairman of the initiative, the Vice President is travelling the world to meet cancer experts and survivors, philanthropists and government leaders. The VCCC Project itself has provided a brand new home for the Peter MacCallum Cancer Centre and new cancer research and clinical facilities for Melbourne Health (including the Royal Melbourne Hospital), new cancer research facilities for The University of Melbourne and new education facilities for all building partners. Peter MacCallum Cancer Centre patients, doctors and nurses moved into their modern new home at the VCCC in June 2016 and the new facility includes 160 inpatient beds, 110 same-day beds, eight operating theatres, two procedure rooms and eight radiation therapy bunkers. Overall, the development comprises a new 13-storey building bordering Flemington Road, Grattan Street and Elizabeth Street, and the construction of four new floors on top of the existing Royal Melbourne Hospital (RMH). The new building and the extension to Royal Melbourne Hospital will be linked by covered bridges above Grattan Street, allowing patients, visitors and staff to move between the two buildings. The new building features space for more than 1,200 cancer researchers. The translation of research discoveries into new treatments will be enhanced with cancer researchers from leading organisations working side by side or within close proximity, and also alongside cancer clinicians and their patients, maximising opportunities for collaboration and sharing of information.
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WELCOME
MURDOCH CHILDRENS RESEARCH INSTITUTE – PARTNER The Murdoch Childrens Research Institute (MCRI) is delighted to join the VCCC to grow our capacity in cancer research. The MCRI is part of new collaborations in cancer immunology, paediatric cancer models and genomic diagnostics, which will significantly increase the critical mass and focus on paediatric cancer. The MCRI believes that the collaboration with our VCCC partners will provide the pathway for new discoveries in childhood leukaemia, cancer immunotherapy and molecular diagnostic trials. The research partners also support the Zero Childhood Cancer initiative, which aims to create a national personalised medicine program for infants, children and adolescents with high-risk cancers that typically have poor outcomes. If fully implemented, it would allow every newly diagnosed paediatric cancer patient in Australia with hard-to-treat disease to have their therapy tailored to the tumour’s genetic characteristics. The Murdoch Childrens Research Institute is the largest child health research institute in Australia. About 1900 researchers work across a broad range of research from laboratory science to large population studies. MCRI is renowned as a world leader in many different areas of paediatric research including allergy, immune disorders, genetics, cancer, stem cell technology and population health. The Institute is co-located with campus partners The Royal Children’s Hospital and the University of Melbourne, with many researchers holding multiple appointments. This unique position allows MCRI to translate discoveries in laboratory, clinical and public health research into real benefits to help children around Australia and the world live healthier, happier lives. In 2016, the Institute marked its 30th anniversary. Founded in 1986 by two visionaries, genetics pioneer Professor David Danks and philanthropist Dame Elisabeth Murdoch with other committed supporters, Danks envisioned a future where genetics would one day become part of standard patient care. MCRI Director Kathryn North shares this vision and with Deputy Director Professor Andrew Sinclair, leads the Australian Genomics Health Alliance, a national research program committed to the integration of genomic medicine into Australian healthcare.
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VCCC PROGRAM UPDATES
The Third Psycho-Oncology Research Conference. Working Together; Reducing the Impact of Cancer for Patients and Families. Discussion led by the following:
KNOWLEDGE TRANSLATION AND COLLABORATION WITHIN TUMOUR STREAMS AND CANCER THEMES
Professor Mei Krishnasamy, University of Melbourne.
The VCCC Research and Education Leads program is designed to investigate, test, evaluate and improve how knowledge translation and collaboration is achieved within the framework of tumour streams or other cancer themes. It’s aim is to improve the integration of new research and education into routine clinical care and to expand translational research opportunities.
Ms Caroline Nehill, Cancer Australia. Professor Gary Rodin, University of Toronto.
The VCCC Research and Education Lead Program
In July 2015, the VCCC established three two-year “proof of principle” projects that aimed to show how research and education/training could be better embedded into routine clinical practice to support optimal care for cancer patients. The VCCC Research and Education Leads for two tumour streams and one cancer theme who were appointed were: • Haematology Tumour Stream – Professor Andrew Roberts • Melanoma and Skin Cancer Tumour Stream – Professor Grant McArthur • Primary Care Cancer Theme – Professor Jon Emery The primary aim of the first year of the pilot projects was to develop an evidencebase on which to improve performance in cancer research and education/ training, and optimally integrate research and education/training with clinical care to improve patient outcomes. The first step was to “map” education and research activities for each of the three pilots across all the VCCC partner organisations. Semi-structured discussions were held with key individuals and/ or groups across a range of professional levels and fields. Observational data was also gathered from seminars, multidisciplinary meetings and other educational meetings. In addition, the VCCC Research Census, VCCC bibliometric analyses and VCCC clinical audits provided some baseline data.
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The haematology pilot was characterised by strong biology and clinical research programs. This indicated there was significant potential for a Research and Education Lead in this tumour stream to work to better integrate these research fields. Existing collegiate relationships and referral pathways between clinicians in different VCCC partner organisations were reported, suggesting that strategies to enhance clinical trial participation, especially those involving cross-referral of patients to different trial sites, could be trialled in this tumour stream. A haematology workshop on molecular literacy in haematologic malignancies for clinicians and researchers was a success. It demonstrated that education in specialised topics can be identified within the tumour stream framework and that the identified knowledge gap can be adequately addressed using a workshop/ short course format. The melanoma and skin tumour stream pilot provided a number of exemplars of effective mechanisms for collaborative research, particularly in models or platforms (such as the Melbourne Melanoma Project). These examples increased the amount, reach and impact of translational and clinical research. This pilot also demonstrated effective mechanisms for increasing collaboration across organisations. It demonstrated both research and education/training could be built upon in other tumour streams especially through joint appointments. The primary care pilot has demonstrated that the Research and Education Lead role has the potential to be a successful model for the translation of research evidence into practice. It facilitated knowledge transfer between researchers and health professionals, advocacy for best practice in education and training, and operationalised evidence-based best practice in hospitals and primary care organisations. Findings included that organisational readiness for translating new research evidence on referral from primary care and shared care with primary care practitioners was largely driven by overloaded screening services and outpatient clinics at VCCC partner hospitals. The availability of relevant and local research data was identified as a key component. It could make the case for change within their own organisation to drive changes in practice that would improve efficiency, cost effectiveness and access and reduce waiting times for patients.
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BUILDING RESEARCH CAPACITY THROUGH INVESTMENT IN RESEARCH LEADERS The Leaders in Cancer Program Censuses of research strengths and gaps across the VCCC have produced a clear picture of research strengths across the VCCC, as well as of gaps that needed to be filled to create a research program that aligns with the breath of research disciplines and fields as in the Comprehensive Cancer Centre models in the US. This evidence has been used to inform the “Leaders in Cancer” program which addresses strategic objectives such as “Developing, retaining and recruiting the best research talent”. Under the “Leaders in Cancer” program, academic appointments (13 Chairs or professorial posts and 7 fellowships) have been created that have retained research talent in leukaemia research, melanoma and skin cancers research and cancer nursing research, further developed research talent in cancer genomics, palliative medicine, haematology, paediatric cancer genomics and surgery, and recruited (or recruiting) new research talent in primary care cancer research, cancer health services research, translational proteomics, data science, surgical oncology and psycho-oncology. This program has generated significant investment by the University of Melbourne in its cancer research program and leveraged funding from a number of sources including VCCC partners and philanthropy. The most recent appointment under the Leaders in Cancer Program is Professor Jennifer Philip as the Chair of Palliative Medicine. This role is a joint appointment between St Vincent’s Hospital Melbourne and the Melbourne Medical School in the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne. Professor Philip is a medical specialist with a commitment to research-driven, evidence-based palliative cancer care. This Chair of Palliative Medicine will provide academic leadership to promote multi-disciplinary palliative cancer care and research in partnership with the Centre for Palliative Care at St Vincent’s Hospital Melbourne as well as with palliative care services across the VCCC clinical partners, and will contribute to the VCCC goals to integrate high-impact research with improved clinical care and teaching.
Photo courtesy of Walter and Eliza Hall Institute
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CELEBRATING THE FUTURE LEADERS IN CANCER The 2016 Picchi Brother Foundation Excellence in Student Research Awards This year was the fourth year of the prestigious Picchi Brothers Foundation Excellence in Student Research (PhD) Awards, which are administered by the VCCC. These two prizes acknowledge the excellent work being done by research higher degree students within VCCC partner organisations. This year’s winner in the science category was Daniel Cameron, a PhD student at the Walter and Eliza Hall Institute of Medical Research, while the clinical research award went to Dr David Liu, a trainee surgeon at the Peter MacCallum Cancer Centre. The selection panel described the work of the two winners as original, innovative and of outstanding quality. Mr Cameron’s work focuses on developing new and improved ways to analyse the huge amounts of data produced by modern genomics, in particular, the accurate identification of genome rearrangements present in many cancers. Although rearrangements are the driving force behind some cancer sub-types, a lack of tools to identify and characterise them has meant that they are underrecognised in genomic analyses of human tumours. Mr Cameron developed mutation detection software, called GRIDSS, to address this problem. The GRIDSS software won in its category in the international ICGC-TCGA Somatic Mutation Calling Challenge in 2015. The goals of this challenge were to identify the most sensitive and accurate mutation detection algorithms. In a research setting, GRIDSS has been used to model tumour heterogeneity and cancer evolution and in a clinical setting, it has been used to identify patient-specific genetic biomarkers to monitor relapse with high sensitivity and specificity. Work is now underway to incorporate GRIDSS into routine clinical analysis as part of the Peter Mac sequencing pipeline. The goal of this work is to identify how these mutations are driving cancer development so that treatments can be tailored to the individual patient.
Professor Jim Bishop AO, MD MMed MBBS FRACP FRCPA, Executive Director, Victorian Comprehensive Cancer Centre, Herman Chair of Cancer Medicine, University of Melbourne. Mr Daniel Cameron (Recipient) PhD Student, Walter and Eliza Hall Institute of Medical Research and the University of Melbourne. Dr David Liu (Recipient) PhD Student and trainee surgeon, The University of Melbourne and the Peter MacCallum Cancer Centre. Dr Edward L. Trimble, MD, MPH, Director, National Cancer Institute for Global Health, Rockville, Maryland, USA. Mr Joseph Lukatis, Chair, Picchi Brothers Foundation.
Dr Liu’s research focuses on investigating novel therapeutic strategies to treat oesophageal cancer, a disease that is rapidly rising in incidence, and yet continues to have poor outcomes. Dr Liu’s results demonstrate the potent efficacy of a new drug which boosts the effects of chemotherapy and kills cancer cells which harbour p53 gene mutations – the most common mutation in cancer. Dr Liu’s work forms the basis of a Phase II multi-centre clinical trial for patients with late-stage oesophageal cancer, which is set to commence in late 2016. This achievement clearly demonstrates the importance of Dr Liu’s work in improving the clinical outcomes for those with oesophageal cancer. Dr Liu’s research has been published in a number of peer-reviewed journals, including top-tier publications in the field of gastroenterology and he is now looking to further collaborate with a group in Europe to increase his research output, while also learning new surgical techniques. Mr Cameron and Dr Liu will each receive a $10,000 scholarship from the Picchi Brothers Foundation to enable them to present their research findings at important international scientific meetings in 2016.
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LEADERSHIP TRAINING FOR CANCER RESEARCHERS AND HEALTHCARE PROFESSIONALS A selection of participant feedback from the second program included: “Informative, thought provoking and more sophisticated than some of the other management courses I’ve been to over the years.” “An excellent leadership course in general and in the context of the VCCC.” “Great opportunity to build collaborations and understand some leadership concepts.” “Brilliant content and delivery.” “Thank you so much it’s been a privilege to attend this course. I confess to some precourse scepticism and have enjoyed being chastened.” “I think this programme was really quite clever in the way it benefitted both the participants and the VCCC. Everyone benefitted, which is always the best.” “This was a good use of my time.” “Just keep doing it.”
Research Leadership Development Program The VCCC recognises that the transition from senior post-doctoral researcher to research leader is a challenging one. In order to prepare those VCCC researchers who are ready to make that transition, the VCCC has sponsored places on the Marlow Hampshire Research Leader Development Program in 2016. This is the second time that the VCCC has offered places on this course. So far a total of 20 researchers have been sponsored for this course. The Marlow Hampshire program has been designed and developed specifically to assist the transition of post-doctoral researchers into effective leaders of research teams with the culture of a research institute or research group. Program outputs include: • Leadership and management skills including strategic thinking, team building and conflict resolution • Emotional intelligence skills • Understanding factors which influence job satisfaction and employee retention • Better understanding of research ethics • Design of a practical plan to implement the program learnings in the workplace Formal evaluation of this program revealed a high level of participant satisfaction, while informal feedback from this year’s participants provided strong encouragement to continue sponsoring places on the program.
VCCC Leadership Program The VCCC Leadership Program was custom designed for the VCCC by the Melbourne Business School and Mt Eliza Executive Education. This program focuses on leadership in an alliance environment ie influencing skills, to work across institutional boundaries where there is not a clear organisational structure. It is targeted to cancer researchers and clinicians. One of the key benefits for participants is meeting peer researchers and clinicians from other VCCC partners, which in turn facilitates multi-disciplinary and multi-partner collaborations. The second VCCC Leadership Program was held over five days in May to July, 2016 with participants from each VCCC organisation, primarily senior clinicians, clinician-scientists and researchers. Participants rated the program content very highly in a formal evaluation conducted by the Melbourne Business School. Ratings improved between the first and second iterations of the program, confirming the value of the evolving program design that was enabled by the VCCC working in partnership with Melbourne Business School and Mt Eliza Executive Education.
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IMPROVING ACCESS TO AND USE OF HEALTH DATA FOR RESEARCH The Health Data Platform Through the VCCC Research Census and other consultations, access to health data has been consistently identified as a barrier to research, in particular health services research. The VCCC has initiated a data linkage project that aims to bring together patient data as an enabler for research. It is building a data platform in an iterative fashion by first linking data from our partner hospitals. We are currently working with each VCCC Partner Hospital to identify the relevant data and datasets that are stored electronically in data warehouses for linkage. The principle behind this work is to make the most of electronic clinical and administrative data that is already collected by the VCCC hospitals. Existing barriers to better use of existing health data include inconsistencies in the data items collected and incompatibilities in the structure of data collected in different organisations. The health data platform program accepts the current data environment and is designed to test and validate alternate approaches to make the most of existing retrospective health data. Current work is focussed on analysing, describing and validating the data that has been contributed by VCCC hospitals to date. As part of this program, methods to measure uncertainty in data are being tested and validated so that even inconsistent data can be better used while minimising over-interpretation. The platform is being designed to be flexible and updated periodically, and to adapt and grow through data linkage as new data becomes available. While data linkage is flexible and cost-effective compared to data integration, it creates complex data structures that are more difficult to analyse. This program will therefore concomitantly build new research capability in data sciences, particularly in ‘big data’ analytics. The VCCC has aligned the first data linkage research project using this Health Data Platform to health services research to reflect the data currently available. This research project aims to conduct the first large-scale, comprehensive data linkage of primary care and hospital data for cancer patients. This aligns with the Comprehensive Cancer Centre model of better integration, both of research to clinical care and of different parts of the healthcare sector. Lack of integration across healthcare sectors is widely cited as one reason for less than optimal health and wellbeing outcomes. This project will improve evidence around cancer patient transitions between the primary care and hospital sectors through data linkage and analysis of cancer patient data at the three key points where the primary care and hospital systems intersect across the cancer journey: • Diagnosis • During acute cancer treatment • Post-cancer treatment follow up care
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Proposed model for Record Linkage for VCCC/UoM Project Linkage of hospital and primary care data to drive improvements in cancer care, February 2016 VCCC Hospital dataset1 Victorian Cancer Registry2
Linked VCCC Hospital dataset
VCR data with VCCC identifiers
NPS Primary Care dataset
Identifiers3
Linked dataset to identify cancer cohort
Final linked dataset
Identifiers3
Other Primary Care dataset
1 Up to 6 VCCC hospitals to be included. Test linkage on 2 hospitals. Dataset includes data submitted to state government (VAED, VEMO, VNAH etc) plus other administrative and costing data TBD in conjunction with each hospital. Data from approx. 2005-2014. Refreshed yearly. 2 Data from approx. 2000-2014. Use of consolidated records vs individual notifications to be discussed. Time period for refreshment TBD. 3 GRHANITE hashed.
Identifiers BioGrid linkage service
VCR linkage service
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INSIGHTS INTO GENOMICS FOR CANCER MEDICINE The Molecular Tumour Board Rapid technological advances in DNA sequencing have brought personalised cancer medicine from the laboratory bench into the patient consulting room. Physicians increasingly need to navigate complex genomic landscapes to find the most effective therapy for patients. However, most oncologists are not sufficiently trained in interpreting complex cancer genomics. In 2013, the VCCC established Australia’s first Molecular Tumour Board (MTB) to provide expertise in the interpretation of genomic data from individual patients’ tumours. Clinicians are invited to submit cases of cancer patients who have had molecular pathology testing involving DNA sequencing. A team of oncologists, clinician-scientists, bioinformaticians, basic scientists, pathologists and geneticists attend monthly MTB meetings where DNA sequencing results and their potential to alter to alter clinical management of the patient are discussed. Clinical case histories, DNA tests and pathology reports are reviewed and the interpretation is fed back to the referring clinicians. The MTB provides genomic test interpretation not only from cancer clinicians, but has also engaged leading molecular scientists from across the VCCC to provide their insights into the potential therapeutic implications of each patient’s tumour DNA sequence. To date, an average of 23 clinicians and scientists have attended each MTB, with an average of 36% of attendees being scientists. By engaging both clinical and scientific experts in the molecular and cell biology of cancer, the MTB has demonstrated that it is an effective forum for the translation genomic data to assist clinical interpretation of molecular profiling. An evaluation of the pilot phase of the MTB showed that it provided additional clinical input in 83% of cases, with a change in patient management occurring as a result of the MTB recommendations in 38% of cases and referral to a clinical trial in 24% of cases. The MTB has begun to align itself with other genomics initiatives, including the Melbourne Genomics Health Alliance, to enable it to move out of pilot phase and become integrated into the routine system of multi-disciplinary meetings at VCCC hospitals. The MTB is also interpreting and evaluating results from a Whole Exome Sequencing pilot project that aims to assess the feasibility of performing wholeexome sequencing on tumour biopsies from patients with advanced cancer.
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ADDING VALUE TO GENOMICS The ACRF Translational Proteomic Facility In 2014, the VCCC and the University of Melbourne was awarded $2,000,000 in funding from the Australian Cancer Research Foundation (ACRF) to create the ACRF Translational Proteomic Facility. It is the first dedicated facility in Australia with the capability for protein-based clinical assays that will complement the increasing use of genomics to inform the treatment of cancer patients with targeted cancer therapies. The ACRF Translational Proteomic Facility comprises three separate technologies: • A Vectra 2 microscope for multiplexed fluorescent immunohistochemistry located in the Microscopy Core in the VCCC building and managed by Associate Professor Sarah Ellis. • New capabilities in Reverse Phase Protein Arrays is located in the Victorian Centre for Functional Genomics (VCFG) led by Associate Professor Kaylene Simpson • The ACRF Translational Proteomic Laboratory, which has leveraged the expertise in the Bio21 Institute managed by Dr Nicholas Williamson and led by Professor Malcolm McConville and Professor Gavin Reid. The Bio21 Institute has been able to leverage the funding from the ACRF Translational Proteomic grant, approximately two times as part of a partnership with Thermo Fisher Scientific, or approximately $2,000,000 in leveraged funding. In addition, a Thermo development chemist embedded at the Bio21 Institute will work with VCCC researchers.
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UNDERSTANDING THE PATIENTS’ EXPERIENCE OF CANCER 2015 Cancer Patient Experience Survey In 2013, the VCCC conducted the first Cancer Patient Experience Survey across all VCCC partner hospitals. Findings from this survey were used to prioritise seed funding for projects in clinical practice improvement. Two projects were completed in 2015 including development of consumer-led training modules for health care workers by the Cancer Patient Experiences team at Peter Mac and a patient information resource for rare cancers developed by the Royal Melbourne Hospital. In 2015, the VCCC commenced the second round of the Cancer Patient Experience Survey across 7 clinical sites. The survey compared local cancer patient experience with international benchmarks using the National Health Service (NHS) England Cancer Patient Experience Survey. This is the largest survey of its type that is specific to cancer to be conducted in Australia. With Austin Health joining the VCCC partnership in 2014, an extra site was included in the 2015 Cancer Patient Experience Survey. Fieldwork commenced in July 2015 and is anticipating to finish in September 2016. Interim results indicate some changes compared to the 2013 Cancer Patient Experience Survey, including fewer patients being offered access clinical research and poorer integration of care after leaving hospital. Access to clinical nurse specialists remains low. However, there has been improvement in access to written information about tests and operations across the VCCC. A full analysis and report of the findings will be available in 2016. An on-line portal has been developed to provide realtime access to survey results.
Photo courtesy of Walter and Eliza Hall Institute
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A SPOTLIGHT ON LUNG CANCER Lung Cancer Clinical Audit Lung cancer remains the leading cause of cancer deaths in Victoria, with a 5 year survival of only 16%. The Victorian Comprehensive Cancer Centre (VCCC) and Western and Central Melbourne Integrated Cancer Service (WCMICS) undertook a clinical audit for lung cancer in which UK Lung Cancer Clinical Audit data items adjusted for the local context and applied across VCCC partner hospitals. The aim of the audit was to evaluate clinical activity, process and outcomes data against clinically relevant indicators. The data collected as part of this audit indicated that, overall, VCCC hospitals are performing at a similar or better level than in the UK for most of the headline indicators audited. However, there were limitations in the interpretation of audit results due to a significant amount of missing data for some of the items and challenges in interpretation of the medical records. Based on the initial findings from this audit, areas for further work include: • documentation of tumour stage for all patients • documentation of MDT discussion for all patients • ensuring consideration of chemotherapy for all appropriate patients • improved documentation of referral of appropriate patients to palliative care services. A clear finding from this audit is the lack of documented access to a lung cancer nurse specialist for lung cancer patients. Many VCCC hospitals employ dedicated lung cancer nurses, however workforce capacity should be addressed. In other tumour streams, such as breast cancer, it is accepted that access to a dedicated nurse specialist should be routine for all patients due to the large evidence base for improved patient outcomes and experience. It is hoped this audit will highlight the need for all lung cancer patients to have access to this essential support.
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WORKING WITH CANCER PATIENTS Patient and public engagement activity In January 2015, the VCCC surveyed each hospital partner’s current approach to engaging with cancer consumers and benchmarked these against Cancer Australia’s National Framework for Consumer Involvement in Cancer Control (The Framework). Identification of gaps between VCCC hospitals and the Framework led to the following recommendations: 1. The VCCC should provide funding and resources for a staff education program. 2. The VCCC should provide funding to support consumer education. 3. The VCCC should develop a working group to scope and develop patient-topatient support programs within each VCCC hospital partner. 4. The VCCC should collaborate with Western and Central Melbourne Integrated Cancer Service (WCMICS) on their Consumer Partnership Work Plan to develop a VCCC wide database of consumers and implement a process to collectively recruit consumers from diverse backgrounds and tumour streams. Two groups were developed to lead this activity. A Cancer Consumer Advisory Committee (CCAC) was formed with representation sought from public and patient representatives from each VCCC partner hospital. The CCAC reports directly to the VCCC Board. A Consumer Leads Network was also convened with representatives who lead consumer engagement work across the VCCC partnership. Following consultation with both the Consumer Leads Network and the VCCC Cancer Consumer Advisory Committee, the VCCC offered places on three different training programs to consumers and healthcare professionals associated with the VCCC partnership.
VCCC Consumer Training Program The first bespoke VCCC Consumer Training Program was held in June 2016 and comprised two half days of training. The focus of the training was to develop consumer leadership capacity by developing consumer knowledge and skills. Evaluation of the program found that100% of attendees would recommend this course to others. In addition, participants reported that it was a valuable networking opportunity and provided information and further understanding about the VCCC. This training also provides a network of consumers who can engage with future VCCC activities.
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VCCC Scholarships The VCCC offered scholarships for the accredited Graduate Certificate in Consumer and Community Engagement (for health professionals) and the Consumer Leadership ( for consumers) training programs that are run by the Health Issues Centre in May 2016. In total, 11 health professionals and 9 consumers received scholarships to attend these courses. The aim was to provide both consumers and health professionals within our clinical and research partners with the training they need to engage in consumer activity. These accredited courses are aligned with and facilitate the implementation of the Australian Commission for Safety and Quality in Healthcare Standard 2: Partnering with consumers. The scholarship opportunities were well received and all applicants were funded to attend the appropriate course. Evaluation to date suggests the scholarships provide increased access for health professionals to training in consumer engagement. For consumers, this course was assessed as relevant and useful by those who were new to consumer engagement. For more experienced consumers, the VCCC Consumer Training Program may be more appropriate.
VCCC breakfast seminar A breakfast seminar entitled “Public and Patient Involvement: Building partnerships across the VCCC” was held in July 2016 and attracted over 100 participants. The aim of the seminar was to educate health professionals on the benefits on engaging with the public. A further objective was to reframe the discussion away from ‘consumers’ towards engagement with the public, and to provide examples of where public engagement has driven health service improvement and the research agenda. Overall, the response to the event was positive, with participants rating the seminar highly. Feedback included that there was an appetite for further engagement by patients and the public with cancer research.
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FINANCIAL STATEMENTS
INTRODUCTION This is the Financial Report of the Victorian Comprehensive Cancer Centre joint venture for 2016. The Victorian Comprehensive Cancer Centre is an unincorporated entity which was formed when the Member Entities entered into a Joint Venture Agreement on 11 November 2009 for the purpose of establishing a comprehensive cancer centre in Victoria. A description of the nature of the joint venture operation and its principal activities is included in the Review of Operations. For enquiries in relation to the Financial Report: please call: + 61 3 8559 7064 or email to: craig.zanker@unimelb.edu.au
GLOSSARY Victorian CCC, or VCCC - Victorian Comprehensive Cancer Centre joint venture Victorian CCC Ltd, or The Company - Victorian Comprehensive Cancer Centre Ltd AASB - Australian Accounting Standards Board DHHS - Department of Health & Human Services, Victoria GST - Goods and Services Tax VAGO - Victorian Auditor-General’s Office State - The Crown in the right of the State of Victoria ICT - Information & Communications Technology
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JOINT VENTURE INFORMATION The Member Entities entered into a Joint Venture Agreement on 11 November 2009 for the purposes of establishing a world leading comprehensive cancer centre in Victoria. The Member Entities in Clause 8 of the Joint Venture Agreement agreed to appoint the Victorian Comprehensive Cancer Centre Ltd (the Company) to manage the joint venture. Clause 8 of the Joint Venture Agreement provides authority to the Company to exercise all the powers and rights of the Member Entities in respect of joint venture assets. Further, Clause 8 of the Joint Venture Agreement provides for the Company to hold all joint venture assets as bare trustee for the Member Entities and their respective beneficial interests.
Member Entities Melbourne Health Peter MacCallum Cancer Institute (trading as the Peter MacCallum Cancer Centre) The Royal Women’s Hospital The University of Melbourne St Vincent’s Hospital Melbourne The Walter and Eliza Hall Institute of Medical Research The Royal Children’s Hospital Western Health Austin Health Murdoch Childrens Research Institute
Principal Place of Business Level 10, 305 Grattan Street Melbourne, Victoria, 3000 Phone: + 61 3 9035 4505
Mailing Address PO Box 2148 Royal Melbourne Hospital Victoria, 3050
Auditors Victorian Auditor-General’s Office Level 24, 35 Collins Street Melbourne, Victoria, 3000
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DECLARATION DECLARATION BY THE MANAGER OF JOINT VENTURE In the opinion of the manager of the joint venture: (i) The. Comprehensive Operating Statement is drawn up so as to present fairly the results of the joint venture for the financial year ended 30 June 2016; (ii) The Balance Sheet is drawn up so as to present fairly the state of affairs of the joint venture as at 30 June 2016; (iii) The Statement of Changes in Equity is drawn up so as to present fairly the results of the joint venture for the financial year ended 30 June 2016; (iv) The Cash Flow Statement is drawn up so as to present fairly the cash flows of the joint venture for the financial year ended 30 June 2016; (v) At the date of this statement there are reasonable grounds to believe that the joint venture will be able to pay its debts as and when they become due and payable. This statement is made in accordance with a resolution of the Board of the Victorian Comprehensive Cancer Centre Ltd, the manager of the joint venture.
L. Kristjanson Chairperson
J. Bishop Executive Director
C. Zanker Business Manager Dated: 9th August 2016 Melbourne
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REVIEW OF OPERATIONS The manager of the joint venture submits the financial report for the year ended 30 June 2016. A review of operations has been included in the Executive Director’s Report.
Significant Events after Balance Date There have been no significant events after Balance Date. Signed in accordance with a resolution of the Board of the Victorian Comprehensive Cancer Centre Ltd, the manager of the joint venture.
Professor Linda Kristjanson Chairperson Victorian Comprehensive Cancer Centre Ltd Dated: 9th August 2016 Melbourne
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COMMITTEE MEMBERS Cancer Education & Training Advisory Committee Geoff McColl (Chair) Jim Bishop Michael Henderson Nicola Quinn Alex Boussioutas (Expert) Bernadette O’Connor Peter Morley Wilma Beswick John Mariadason Katy Weare John Silke Stephen Lew Mei Krishnasamy (Expert)
Cancer Research Advisory Committee Jim Bishop (Chair) Joe Trapani Tony Burgess Mark Jenkins Ingrid Winship Paul Ekert Sue-Ann McLachlan Edward Janus Matthias Ernst Bruce Mann Grant McArthur Andrew Roberts Jon Emery Graham Taylor
Nick Nicola Dallas English Jayesh Desai John Seymour David Ritchie Sean Grimmond
Expert member Expert member Expert member Expert member Expert member Expert member
Finance Audit and Risk Committee Christine Kilpatrick (Chair) Alex Cockram Zak Gruevski David Wallingford
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BOARD MEMBERS The following disclosures are made regarding responsible persons for the reporting period.
Names The persons who held the positions of Ministers and Accountable Officers in the joint venture are as follows:
Minister Health:
The Hon. Jill Hennessy 1 July 2015 to 30 June 2016
Board of Directors Chairperson Deputy Chairperson Director Director Director Director Director Director Director Director Director Director Director Director
R. G. Larkins G. Morstyn S. K. Smith A. M. Cockram D. A. Fisher D. J. Hilton C. J. Kilpatrick G. J. Goodier B. J. Fielding S. M. Matthews B. Murphy K. North J. McCluskey S. J. O’Neill
1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 July 2015 to 1 Sept 2015 1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 July 2015 to 25 Sept 2015 1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 July 2015 to 30 June 2016 1 Sept 2015 to 30 June 2016 1 Feb 2016 to 30 June 2016
Subsequent Events From 1 July 2016 Professor Linda Kristjanson was appointed Chairperson and Professor Robert Thomas OAM was appointed Deputy Chairperson of the VCCC following the resignation of Richard Larkins and George Morstyn.
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COMPREHENSIVE OPERATING STATEMENT for the year ended 30 June 2016 Note
2016 $
2015 $
2(a)
1,460,000
1,596,875
2(a)
1,460,000
1,460,000
Other income
2(a)
195,194
89,361
Interest income
2(b)
51,128
56,080
3,166,322
3,202,316
3(a)
(138,173)
(218,854)
Leaders in Cancer Strategy
3(b)
(288,707)
(78,501)
Clinical Projects
3(b)
(82,363)
(55,049)
Research Projects
3(b)
(239,597)
(647,493)
Education and Training Projects
3(b)
(112,237)
(97,610)
Clinical Research Focus Projects
3(b)
(53,896)
(42,450)
3(c)
(53,754)
(9,624)
Employee benefit expense
3(d)
(1,532,339)
(1,355,061)
Supplies and services
3(e)
(413,414)
(409,243)
Depreciation expense
3(f)
(13,648)
(11,961)
(2,928,128)
(2,925,846)
Net result from transactions (net operating balance)
238,194
276,470
Comprehensive result
238,194
276,470
Income from transactions Contributions from Member Entities Contributions from Department of Health & Human Services
Total income from transactions Expenses from transactions Reduce Cancer Burden Living with Cancer Centre of Excellence
Increased Investment New Funding Streams Strategy Other expenses
Total expenses from transactions
This Comprehensive Operating Statement should be read in conjunction with the accompanying notes included on pages 11 to 33 of the full VCCC Annual Report 2015-16, available at www.victorianccc.org.au.
VCCC ANNUAL REPORT 2015-16 | 27
BALANCE SHEET as at 30 June 2016 Note
2016 $
2015 $
Cash and cash equivalents
4
2,565,567
2,168,920
Trade and other receivables
5
37,611
43,777
Prepayments
6
Assets Current assets
Total Current assets
38,794
25,316
2,641,972
2,238,013
9,596
-
38,292
40,215
47,888
40,215
2,689,860
2,278,228
Non-Current assets Investment in Cancer Therapeutics CRC Property, plant and equipment
7
Total non-current assets Total assets Liabilities Current liabilities Trade and other payables
8
538,454
455,009
Provisions
9
420,650
342,863
959,104
797,872
Total Current liabilities Non-Current liabilities Provisions
9
52,857
40,651
52,857
40,651
Total liabilities
1,011,961
838,523
Net assets
1,677,899
1,439,705
Total Non-Current liabilities
Equity Accumulated Surplus
1,677,899
1,439,705
Total equity
1,677,899
1,439,705
Contingent assets and contingent liabilities
17
Commitments for expenditure
18
This Balance Sheet should be read in conjunction with the accompanying notes included on pages 11 to 33 of the full VCCC Annual Report 2015-16, available at www.victorianccc.org.au.
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STATEMENT OF CHANGES IN EQUITY for the year ended 30 June 2016 Note
Equity at 1 July 2015
Total comprehensive result
Equity at 30 June 2016
$
$
$
Accumulated surplus
1,439,705
238,194
1,677,899
Total equity at end of financial year
1,439,705
238,194
1,677,899
Equity at 1 July 2014
Total comprehensive result
Equity at 30 June 2015
$
$
$
Accumulated surplus
1,163,235
276,470
1,439,705
Total equity at end of financial year
1,163,235
276,470
1,439,705
2016
Note
2015
This Statement of Changes in Equity should be read in conjunction with the accompanying notes included on pages 11 to 33 of the full VCCC Annual Report 2015-16, available at www.victorianccc.org.au.
VCCC ANNUAL REPORT 2015-16 | 29
CASH FLOW STATEMENT for the year ended 30 June 2016 Note
2016 $
2015 $
Receipts from Members
1,460,000
1,596,875
Receipts from Department of Health & Human Services
1,810,000
1,460,000
Cash flows from operating activities Receipts
Receipts from Customers
183,477
93,127
Goods and Services Tax received from the ATO
156,016
138,007
50,254
60,934
3,659,747
3,348,943
Payments to suppliers and employees
(3,241,779)
(2,946,920)
Total payments
(3,241,779)
(2,946,920)
417,968
402,023
Payments for non-financial assets
(21,321)
(16,711)
Net cash flows used in investing activities
(21,321)
(16,711)
Net increase in cash and cash equivalents
396,647
385,312
2,168,920
1,783,608
2,565,567
2,168,920
Interest received Total receipts Payments
Net cash flows from operating activities
11
Cash flows from investing activities
Cash and cash equivalents at the beginning of financial year Cash and cash equivalents at the end of financial year
4
This cash flow statement should be read in conjunction with the accompanying notes included on pages 11 to 33 of the full VCCC Annual Report 2015-16, available at www.victorianccc.org.au.
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VCCC ANNUAL REPORT 2015-16 | 31
32 | VCCC ANNUAL REPORT 2015-16
The Victorian Comprehensive Cancer Centre, a joint venture between: The Victorian Comprehensive Cancer Centre, a joint venture between:
victorianccc.org.au
victorianccc.org.au