Applying the Interprofessional Model to Clinical Trials at the Odette Cancer Centre
THIS IS AN EXCERPT FROM THE 2016-2017 ANNUAL REPORT.
L to R: Joe Presutti, Melanie Davidson, William Chu, Marko Cadonic, Andrew Loblaw
Imagine a cancer treatment that improves wait times, benefits patients and saves the healthcare system millions, without any trade-offs. It may sound like fiction, but one such treatment is being studied at cancer centres around the world.
The Prostate Advances in Comparative Evidence (PACE) study is being led by The Royal Marsden and is taking place at several cancer centres internationally. In Canada, this Phase III clinical trial began at the Odette Cancer Centre (OCC), and is now recruiting patients at nine other Canadian centres.
Stereotactic Body Radiotherapy (SBRT) for prostate cancer presents multiple benefits to different areas. Reducing the number of treatment sessions from 39 to 5 saves the average patient approximately $2,000 in parking and driving costs. The Departmental Program cost is also reduced by 75%; rendering available treatment slots for additional patients. With benefits across the healthcare system, can SBRT become the new standard for patients with prostate cancer? This is a question the PACE team will be exploring over the next five years.
Dr. William Chu, Assistant Professor at the Department of Radiation Oncology, University of Toronto (UTDRO), is the Canadian lead for this study. As a radiation oncologist in OCC’s genitourinary (GU) group, he explained that his team has a track record of successfully using SBRT to treat prostate cancer. “When the Royal Marsden invited us to participate in this study, we were happy to sign on. This is the first and largest randomized Phase III trial comparing standard radiation treatment, to SBRT for prostate cancer. It addresses our mandate to innovate prostate cancer treatment internationally.”
When OCC signed on to PACE, funding for the trial was non-existent outside the United Kingdom. Dr. Andrew Loblaw, GU site lead at OCC and Professor at UTDRO, recognized the need to raise funds to support this trial across Canada. “This is a very important trial for prostate cancer treatment and it aligned with our goals to improve outcomes,” he said. “But without funding, this trial wouldn’t get off the ground.” Therefore, his charity organization, Prostate Cure Foundation raised $1 million over six months; allowing the future recruitment of 200 patients into PACE across Canada.
With funding in place, William and Andrew started the process for legal approval in 2015 and within a year they were able to start recruiting patients. “We were aiming for 200 Canadian patients by 2020, but more centres have signed on in Canada and internationally recently,” William said. “So the accrual numbers have gone up exponentially and we will finish accrual by the end of this year.”
The GU team at OCC spent close to a year preparing for this study. UTDRO Assistant Professor Dr. Melanie Davidson, a Medical Physicist at OCC, worked closely with the GU team to develop the technical aspects of this study including simulations and treatment planning. Dosimetrists on the team developed planning protocols. UTDRO Instructor Joe Presutti is one of the dosimetrists involved with PACE. “Within our interprofessional team, many people were planning SBRT for the first time,” he shared. “So my colleague, Marko Cadonic and I became a resource for anyone who was unfamiliar with SBRT plans.”
After we hammered out all the treatment details and guidelines, we shared this information with other centres.
“The reason why OCC has successfully recruited almost half of the Canadian patients in such a short time is because of our interprofessional team,” noted Andrew. “We work together as a family and complement each other. Every person in our interprofessional team respects each other’s strengths, and works together towards the same goal.”
After the OCC teams were comfortable with SBRT for prostate cancer, Melanie, Joe, Marko and Will held hands-on training sessions with teams at other hospitals. “After we hammered out all the treatment details and guidelines, we shared this information with other centres,” Melanie said. “We are also sharing our protocols, scripts and other information with any centre that needs it. It took us years to develop this information and this resource can be very useful to centres who are starting SBRT from scratch.”
As with any new treatment, SBRT presents some challenges for the new centres. The treatment dose is four times higher than the normal radiotherapy dose, and is administered to an area 60% smaller. This is where the OCC team has stepped in to help; their treatment protocols and scripts help to train the new centres on this treatment.
An additional challenge is getting legal approval. “Since we had already secured funding, we were able to focus on working with other centres and rolling this out faster,” said Andrew. Andrew and William have met with several legal teams across Canada to help guide them through the process and obtain the necessary approvals to start recruiting patients.
While it is too early to comment on the success of this study, it is worth noting that the OCC GU team has successfully launched the study and recruited patients with great efficiency. The interprofessional team not only trained staff at OCC, they disseminated their experience, and helped eight other centres start this study.
For more information about the PACE trial, visit www.prostatecure.ca/sabr.
IMage CREDIT: Horst Herget Photography