World Class Personalized Cancer Medicine - The Princess Margaret Cancer Centre - Strategy 2013-2018
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World Class Personalized Cancer Medicine The Princess Margaret Cancer Centre Strategy 2013-2018
Contents 4 The Princess Margaret Cancer Centre 6 Accountability 7 Our Resources snd Activity 8 Research 9 Education 10 Emerging Trends in Cancer Care 13 Achieving Our Vision: One Strategy, Five Themes 14 The Princess Margaret Cancer Centre Strategy 2013-2018 15 Transform Patient Care 23 Augment Correlative Cancer Biology 29 Accelerate Guided Therapeutics 37 Expand Novel Therapeutics 45 Drive Outreach and Education 50 The Path Ahead 52 Acknowledgements
We are pleased to present the Princess Margaret Cancer Centre Strategy 2013-2018: World Class Personalized Cancer Medicine. This strategy summarizes our goals across five key strategic themes: transforming patient care; augmenting correlative cancer biology; accelerating guided therapeutics; expanding novel therapeutics; and driving outreach and education. The earlier iteration of our strategy, “Translating the Science of Cancer into Practice”, has been under implementation since 2008 and significant progress has been made. Examples of major initiatives aimed at addressing these themes include the redesign of our ambulatory care model, establishment of our Phase I clinical trials unit, development of our translational image-guided operating rooms, implementation of the TECHNA Institute for the Advancement of Technology for Health, and international programs including partnership with Kuwait. The Princess Margaret Cancer Centre Strategy 2013-2018
3
As we approached the halfway mark of the strategic plan, we
embarked on a revision of our strategy looking forward. We
undertook extensive internal and external consultations to evaluate
our current context and refresh the directions that we have set.
We wished to ensure that our strategy is aligned with the recently
updated strategic plans of the University Health Network, the
Ontario Cancer Plan III, the Ontario Cancer Institute, and the
University of Toronto. Most especially, we want to align with the
Princess Margaret Cancer Foundation’s “Believe It” campaign for
personalized cancer medicine.
We look forward to achieving our goals and delivering world
class personalized cancer medicine at the Princess Margaret
Cancer Centre.
MARNIE ESCAF, MHA, HBBA
Executive Lead, Princess Margaret Cancer Centre
Senior Vice President, University Health Network
MARY GOSPODAROWICZ, MD, FRPC, FRCR (Hon)
Medical Director, Princess Margaret Cancer Centre
University Health Network
4
The Princess Margaret Cancer Centre at the University Health
Network (UHN) in Toronto, Canada is a comprehensive cancer centre
that offers a full suite of cancer services at the community, regional,
provincial and international levels. We are a key resource for complex
cancer care spanning the continuum from diagnosis to palliation and
survivorship, across all disease sites.
Under the auspices of Cancer Care Ontario, the Princess Margaret is
responsible for the Toronto Central South Regional Cancer Program,
which includes the Princess Margaret and UHN, Mount Sinai Hospital,
St. Joseph’s Health Centre, St. Michael’s Hospital and Women’s
College Hospital, in collaboration with Toronto Central Community
Care Access Centre and Toronto Central Palliative Care Network.
The Princess Margaret is organized by disease site groups and
clinical departments, including allied health professionals, medical-,
radiation- and surgical oncologists, oncology nurses, psychiatrists,
and other clinical staff.
The
Princess Margaret
Cancer Centre
5 PRINCESS MARGARET CANCER CENTRE
6
As a publicly funded cancer centre, the Princess Margaret is
accountable to its patients, the provincial government, its donors
and other external funders. We are a University of Toronto teaching
hospital and are accountable to the university in this regard.
We are responsible for quality of care and equity imperatives and are
committed to meeting provincial targets for access to care, treatment
volumes and financial benchmarks.
With the increase in our patient populations, it is expected that
our cancer centre will continue to grow at a rate of approximately
1-3% per year for the foreseeable future; we must secure adequate
resources required to deliver the highest quality care as safely and
efficiently as possible.
accountability
7
The Princess Margaret has 218 inpatient beds, 350
ambulatory clinics, approximately 398,000 sq. ft. of
research space and 800,000 sq. ft. of clinical space,
employing over 3,000 staff. Our 2012 clinical activity is
summarized below:
2012 Volume
12,818
New Patients. . . . . . . . . . . . . . . . . . . . . . . .
Cancer Surgeries . . . . . . . . . . . . . . . . . . . . . . 4,047
Outpatient Chemotherapy Treatments . . 31,022
Courses of Radiation Treatment . . . . . . . 10,150
Stem Cell Transplants. . . . . . . . . . . . . . . . . . . . 319
We opened over 100 clinical research
studies in 2012 and more than 3,800
subjects participated in clinical research
at the Princess Margaret during that period.
our resources
and activity
8
Our research institute, the Ontario Cancer Institute (OCI), employs
over 300 scientists who conduct research in genomics,
proteomics, structural biology, molecular biology, biophysics, stem
cell biology, and behavioural sciences.
OCI provides education at the undergraduate, graduate and post-
graduate levels. We trained over 400 graduate students
and research fellows in 2012.
Our researchers employ leading edge tools to analyze cancerous
cells at the molecular level, test gene and cellular therapies for cancer
and other diseases, develop new technologies for diagnosing and
treating cancer, determine the effects of diet and behaviour on cancer
risks, and develop and test informatics tools for the large-scale
analysis of patient populations.
In 2012, our OCI researchers produced 937 publications and
secured close to $150,000,000 in external funding.
research9
At the Princess Margaret Cancer Centre, we provide comprehensive
and integrated education for undergraduate, graduate and post-
graduate trainees in medicine, nursing, allied health and other
healthcare specialties. Continuing education is provided across
health professions.
In 2012, we trained over 100 clinical fellows, over 100
nursing students and more than 150 residents. We also
provided training for close to 180 other students, including
trainees in disciplines such as physics and social work.
Training is delivered across the clinical disciplines of pathology,
imaging, surgical oncology, radiation medicine, oncology nursing,
medical oncology, psychosocial oncology and palliative care, as well
as survivorship and patient education.
education10
In order to plan for world class personalized cancer medicine, we
need to be aware of major trends in cancer services and healthcare.
Some of the key emerging trends include:
»» Patients as partners in their care
»» New models of inter-professional care
»» New targeted therapies
»» International collaboration amongst cancer centres
»» Cancer survivorship needs
Strategizing for a “Top Five” cancer centre requires focus, attention
and integration across our core areas of clinical service, research,
outreach and education, as outlined on the next page.
emerging trends
in cancer care11 “As a top five comprehensive cancer care centre, the Princess Margaret will be a leading contributor to conquering cancer within our lifetime.” Clinical Practice Recognized for delivering world-leading patient outcomes through personalized cancer care Research Continuously developing new and improved instruments and interventions that will benefit patients and their families Outreach and Education Sharing our knowledge and expertise to create new generations of cancer care professionals, promote cancer risk-reducing lifestyles and support development of cancer care locally and globally
12
Transform the
delivery of patient care
Augment correlative
cancer biology
Accelerate
guided therapeutics
Expand novel
therapeutics
Drive outreach
and education13
The Princess Margaret Cancer Centre strategic themes support the
personalized cancer medicine agenda and guide us towards our
vision of a world top five cancer institution:
This plan supports patient-centred, personalized cancer care and
empowers patients as partners in their care. The plan gives patients
promise of well documented, best possible outcomes, with the
broader goal of conquering cancer.
In addition to delivering excellent patient care and education, and
continuing to lead in clinical research, our plan supports continuous
quality improvement and innovation.
To support our goals, we must secure continuous development and
renewal of our infrastructure to faciltitate operations and delivery
of excellent care, education and research. This includes attention
to optimal space, information technology support, state of the art
equipment, the best talent, modern clinical processes and robust
quality and risk management programs.
achieving our vision:
one strategy,
five themes14 World Class Personalized Cancer Medicine The Princess Margaret Cancer Centre Strategy 2013-2018
15
transform
patient care
We will transform patient care by developing new models of
inter-professional care, offering support through all the aspects
of cancer care, personalizing cancer care and serving unique
vulnerable populations, as well as empowering patients to
become partners in their care.
Strategic Initiatives
A Personalize and optimize clinic operations
and enhance patients’ experience
B Support patients, families and caregivers
throughout the cancer journey
C Empower patients to become
partners in their care
D Develop new models
of inter-professional care
E Address the specialized needs of
adolescent/young adult and geriatric patients16
A Personalize and optimize clinic operations
and enhance patients’ experience
Rationale
New models of care will strengthen inter-professional practice
and the integration of patient care with research and education
on an ongoing, operational basis, continually improving the
patient experience. Operational and process efficiencies will
improve access to our expertise, and support patient-centred,
high quality care.
Initial Activities
»» Ambulatory care strategy
planning and implementation
to support the highest quality
patient-centred ambulatory
care experience across
integrated, efficient clinics
and services
»» Implement point-of-care
patient education training to
equip all staff and trainees
to deliver personalized
patient education17
B Support patients, families and caregivers
throughout the cancer journey
Rationale
Comprehensive support for symptoms associated with cancer
diagnosis and treatment to improve patients’ quality of life and
increase their satisfaction. The broad range of clinical services
in palliative and supportive care must be applied to all aspects
of clinical encounters.
Initial Activities
»» Implement standardized processes
for responding to Distress
Assessment and Response Tool
(DART) results to address patient’s
symptom management needs
»» Integrate with cancer rehab
services and primary care to
support seamless, integrated
care across the continuum of
cancer services18
C Empower patients to become
partners in their care
Rationale
The quality of clinical interactions will be strengthened through
enhanced clinician communication skills, empowering patients
to become active partners in their care; informed patients are
engaged in their own care, improving treatment compliance
and increasing the potential for improved outcomes and
patient satisfaction.
Initial Activities
»» Develop electronic platforms to provide
patients with access to comprehensive
and ‘user-friendly’ information on
treatment progress, results and
consultation summaries
»» Expand our patient education service to
support access to and engagement in
point of care patient education19
D Develop new models
of inter-professional care
Rationale
Innovative care practices and processes will improve the
patient experience, maximize clinician time and skills, and
increase our capacity to care for growing numbers of cancer
survivors, who require follow-up care.
Initial Activities
»» Pilot virtual/satellite clinic
models to improve access
to our services and offer
care closer to home
»» Implement advanced
clinical documentation to
improve integration across
our information systems
and facilitate access to the
right information in the right place and at the right time20
E ddress the specialized needs of
A
adolescent/young adult and
geriatric patients
Rationale
Adolescents and young adults (AYA) and the frail elderly
with cancer face unique medical and psychosocial needs
and require personalized, appropriate psychosocial support,
information, and services. Creating a holistic approach that
identifies the unique characteristics and circumstances will help
target our care to their specific needs.
Initial Activities
»» Establish an adolescent and young adult oncology program
to address the specialized needs of this patient population in
a coordinated and patient-centred way
»» Develop and implement a standardized approach to
strengthen our ability to assess and tailor treatment plans
that optimize outcomes in the frail elderly21
22
23
augment
correlative
cancer biology
We will accelerate implementation of personalized cancer care
based on a novel understanding of patient and tumour molecular
characteristics, as well as their impact on treatment outcomes,
through expanded correlative cancer biology programs.
augment correlative
Strategic Initiatives
Acancer biology
Implement a fully operational
and robust cancer bio-bank
B stablish a functional relational clinical and bio-specimen
E
database with clinical outcomes
C Invest in leading technologies
to facilitate translational research24
A Implement a fully operational
and robust cancer bio-bank
Rationale
To accelerate implementation of personalized cancer care
based on the understanding of tumour biology, patient-specific
characteristics and treatment outcomes, a fully operational
and robust cancer bio-bank is required. These resources are
essential to understanding outcomes of novel therapeutics
and assessing individual patients’ response to treatment, and
are also crucial for the development of translational medicine.
Initial Activities
»» Continue expansion of our bio-bank to
support collection of full bio-specimen
sets across disease sites
»» Implement expanded systems-level
specimen characterization of bio-banked
specimens25
B stablish a functional relational
E
clinical and bio-specimen database
with clinical outcomes
Rationale
A functional, relational clinical and bio-specimen database contains
medical descriptions of stored specimens, as well as their physical
location, and is necessary for efficient bio-bank usage (e.g. easy
retrieval, search and identification).
Initial Activities
»» Develop and implement integrated databases to optimize
bio-bank usage26
C Invest in leading technologies
to facilitate translational research
Rationale
Translational medicine gives us an enhanced understanding
of which therapies will work and which will not, at the
individual patient level. Achieving this understanding requires
creating linkages between basic and clinical research; new IT
technologies can provide an efficient interface between these
two domains.
Initial Activities
»» Identify and implement potential IT solutions to support point
of care, standardized data collection and allow real-time
patient data sharing between physicians, clinical researchers
and laboratory researchers27
28
29
accelerate guided
therapeutics
We will continue to innovate in guided therapeutics and lead
implementation of new and powerful cancer diagnostics
and treatments supported by a robust foundation of new
informatics including pattern recognition and automation.
augment correlative
Strategic Initiatives
Acancer biology
Expand a coordinated multi-disciplinary innovation
environment through TECHNA
B Create state-of-the-art molecular imaging infrastructure
and research program
C Accelerate effective utilization of advanced robotics
in surgery and interventions
D Strengthen our leadership position in
image-guided intervention
E uild an informatics-supported, user-friendly visualization
B
(“heads up display”) for high performance cancer
intervention, discovery and evaluation
F Establish the leading hospital-based proton therapy
program in Canada30
A Expand a coordinated multi-disciplinary
innovation environment through TECHNA
Rationale
Accelerating advancement in guided therapeutics requires
excellent research and development (R&D) infrastructure and
a framework for innovation. The future of cancer intervention
includes highly coordinated, multi-modal interventions and the
creation of multidisciplinary research environments that enable
these interventions to be explored will be transformative.
Initial Activities
»» Build a multi-disciplinary faculty and a strong management
team at TECHNA to stimulate collaboration and build
global connections in support of innovation in developing
sophisticated cancer treatment trajectories that fully utilize
personal information to maximize the therapeutic ratio31
B Create state-of-the-art molecular imaging
infrastructure and research program
Rationale
Molecular imaging promises to enable minimally-invasive
characterization of the disease state within the human body to
better design and direct intervention. State-of-the-art cancer
interventions will be personalized based upon molecular
signatures from tissue and imaging.
Initial Activities
»» Operationalize cyclotron and fully
implement MR/PET to effectively
use MI agents to provide greater
specificity of the disease and its
response to therapy
»» Establish a molecular imaging (MI)
team to work with clinical and
basic researchers and to support
innovation and impact in MI32
C ccelerate effective utilization of
A
advanced robotics in surgery and
interventions
Rationale
The implementation of robotic surgery has the potential to
improve patient outcomes by enhancing specificity in resection.
Robotic systems promise to increase safety and quality and will
eventually affect cost.
Initial Activities
»» Expand robotic surgery capacity and build novel image-
guided robotics systems to support precision medicine
»» Modify and create training and education
programs to integrate robotic surgery and
robotic interventions
into practice33
D Strengthen our leadership position
in image-guided intervention
Rationale
Guided radiotherapy reduces treatment-associated damage
to healthy tissues by more precisely targeting cancer cells,
which impacts outcomes and has the potential to improve
patients’ quality of life. This is an area of strength, but also of
great importance; this program needs to be strengthened and
supported by more faculty.
Initial Activities
»» Establish a team to create common platforms for optimized
and coordinated multi-disciplinary image guided cancer
intervention, including drug-delivery34
E uild an informatics-supported, user-
B
friendly visualization (“heads up display”)
for high performance cancer intervention,
discovery and evaluation
Rationale
All cancer research and intervention must be based on robust
data; a data-driven approach is needed to provide the best,
high-performance intervention and to accelerate innovation.
Technological advances are providing a wealth of new
information (e.g. genomics) and a coordinated system is needed
to manage access to this information (utilization and input).
Initial Activities
»» Develop and implement a
cancer informatics strategy
to support comprehensive
availability of data to drive
and enable clinical practice,
research and innovation
»» Establish coordinated
visualization of information and
analyses to reduce complexity35
F Establish the leading hospital-based
proton therapy program in Canada
Rationale
Radiation therapy is a highly potent form of cancer treatment.
Proton beams are a more precise and less harmful form of
radiation therapy, especially for young patients. Adoption
by leading cancer programs throughout the world has
demonstrated the capacity to reduce long-term side effects
of the disease and treatment. There is a compelling case for
establishing a proton therapy facility in downtown Toronto
under the leadership of the Princess Margaret Cancer Centre
in collaboration with The Hospital for Sick Children.
Initial Activities
»» Engage stakeholders and
establish a provincial plan for
providing Canadian patients with
appropriate access to a state-of-
the-art proton therapy facility
»» Secure resources, partnerships,
and infrastructure to implement the first comprehensive and
hospital-based proton therapy program in Canada36
37
expand
novel
therapeutics
We will provide patients with access to leading-edge treatment
methods through research and implementation of novel
systemic therapeutics, incorporating molecular imaging and
genomic signatures and improving outcomes for cancer
patients globally.
augment correlative
Strategic Initiatives
Acancer biology
Expand the size and scope of
our Drug Development Program
B Accelerate advancements in immune based therapies
C Introduce innovations in cellular therapy
D Develop novel combined modality approaches
to therapy
E Molecular profiling of tumour and host as part of
routine care38
A Expand the size and scope
of our Drug Development Program
Rationale
A robust program encompassing all phases of early stage Drug
Development will ensure patients at the Princess Margaret
have access to the newest drugs. A comprehensive Drug
Development Program supports our world class research
reputation, integrates our basic and clinical research programs,
and will provide the evidence to improve outcomes for cancer
patients globally.
Initial Activities
»» Build informatics and database systems to support complex
clinical trials
»» Expand inpatient drug development facilities to support the
use of novel therapies across the spectrum of cancer care39
B Accelerate advancements in
immune based therapies
Rationale
Immune therapies improve the ability of patients’ own biological
systems to fight cancer. The genetic diversity of cancer is such
that resistance occurs to many current targeted drug therapies;
activating the immune system to fight the cancer will limit
the development of resistance and will be complementary to
current treatments. Recent advances in understanding of the
immune system make this an area of much greater promise.
Initial Activities
»» Establish a team to support leading-edge immunotherapy
research and translate discoveries to clinical care as
efficiently as possible
»» Establish a lab to provide routine immune
monitoring for patients on treatment and
create dedicated inpatient and
ambulatory facilities for the
immunotherapy program40
C Introduce innovations in cellular therapy
Rationale
High dose therapy followed by infusion of stem cells to restore
the hematopoetic system is currently used to treat and cure a
number of hematological malignancies; new approaches such
as haplo or cord blood expand the pool of recipients for such
approaches. With advances in stem cell research, infusion of
other types of human stem cells to replace damaged tissues
(e.g. after radiation), and facilitate tissue regeneration are
being studied. Other potential uses of cellular therapy include
adoptive immunotherapy with T-cells or NK cells and the use
of dendritic cells for gene transfer.
Initial Activities
»» Create a cord blood transplant program to support a
comprehensive stem cell therapy service
»» Expand our facility for cell and vector production to support
enhanced cell therapy41
D Develop novel combined
modality approaches to therapy
Rationale
Combining novel agents and approaches and integrating
them with established local and systemic therapies will result
in new treatment methods with better outcomes. Traditional
pharmaceutical driven drug development to bring single
drugs to market approval is a slow and inefficient process.
The genetic heterogeneity of cancer is such that combined
approaches will be required.
Initial Activities
»» Enhance imaging capabilities for early detection of
metastatic disease
»» Develop a program to study combination of radiation with
targeted agents42
E olecular profiling of tumour
M
and host as part of routine care
Rationale
We have a much greater understanding of the molecular
diversity of cancer; this diversity can be used to select therapy
that will have a higher chance of therapeutic success. There
have been major advances in technology such that we are now
able to rapidly generate a molecular profile for both the cancer
and the patient.
Initial Activities
»» Conduct genomic profiling using multiplex technologies in
a CLIA-certified laboratory and incorporate analysis and
reporting of genomic profiles into the patient journey and
patient chart
»» Offer access to genomic profiling to patients and centres
across the country43
44
45
drive
outreach
and education
We will strengthen our impact and reputation, contribute to
our communities, improve care and research, and exchange
knowledge through global and local collaborations and
partnerships, as well as education.
augment correlative
Strategic Initiatives
A cancer biology
Foster collaborative programs
across the full spectrum of cancer care
B Amplify outreach in research and education
C Expand national and international collaboration in clinical
and academic cancer programs46
A oster collaborative programs
F
across the full spectrum of cancer care
Rationale
Fostering local and regional collaboration and sharing expertise
will support overall improvements in cancer service quality
across our communities. Collaboration will strengthen the
Princess Margaret Cancer Centre’s reputation as the leading
Canadian centre for cancer treatment and research. Research
cooperation at the local and regional levels will provide the
Princess Margaret with a larger population of patients for
clinical trials and research.
Initial Activities
»» Establish communities of practice to support
collaboration and knowledge sharing both within
and across disciplines to improve outcomes
locally, provincially and globally
»» Implement virtual multi-disciplinary
cancer conferences for a
collaborative approach to
treatment decision making and
improve access to expertise
across disease sites and
treatment modalities47
B Amplify outreach in research
and education
Rationale
Building a global partnership network and sharing Princess
Margaret Cancer Centre expertise internationally will have a
significant impact on strengthening our reputation as a leading
world cancer research centre. Development and dissemination
of innovative models of education and training will foster world
class talent and will enhance our reputation as a leading centre
for cancer research, education and treatment.
Initial Activities
»» Develop, implement and communicate a multi-disciplinary
training curriculum for oncology professionals
»» Expand active research and development partnerships
with global cancer treatment centres to build a
worldwide network of partners48
C xpand national and international
E
collaboration in clinical and academic
cancer programs
Rationale
Collaborative and philanthropic activities aiming to provide
support and exchange knowledge with other national and
international cancer programs will not only build our reputation
as a world leading cancer care institution, but will also support
our continuous learning and development.
Initial Activities
»» Enable an active alumni network to support partnerships with
other cancer institutions and develop fellowship exchanges
to strengthen international outreach and knowledge sharing
»» Develop a philanthropic outreach program to share
our expertise, foster international cancer control and
improve cancer49
the path ahead
51 This strategic plan lays out a comprehensive set of goals to increase the Princess Margaret Cancer Centre’s capacity to deliver on its vision of a world top five cancer institution. It will require continuous optimization of our resources and the engagement of every staff member in the organization to achieve the proposed activities. We will develop and implement these specific initiatives with benchmarks, timelines and metrics to monitor our progress against the goals listed for each theme. This cannot be achieved without maintaining excellence in the delivery of core activities and continuously improving and investing in our infrastructure. As with all plans, this strategy sets the overall direction and focus for the Princess Margaret; however, its success will depend on flexibility in its implementation. The comprehensive set of themes and priorities identified in the plan will be adapted according to our resources and talent. Our strategic plan will drive us toward our goal of accelerating personalized cancer medicine through world class cancer care, and conquering cancer in our lifetime.
52
This plan represents major contributions and input from staff and
would not have been possible without significant participation
from every level and department within the Cancer Centre and the
members of the Princess Margaret Cancer Centre leadership.
Strategic Plan Steering Committee
Mary Marnie Roxana Brian
Gospodarowicz Escaf Sultan O’Sullivan
We would like to thank Stephen Bear, Mark Hanrahan,
Adam Mazur and Benjamin Concessi from McKinsey and
Company for their assistance.
acknowledgementsYou can also read
