Celebrating our three-year anniversary

Today, 1 May 2021, we celebrate three-years of activity of the Cancer Health Services Research group, established as one of the strategic research programs in the Victorian Comprehensive Cancer Centre (VCCC). Since last year we have again made fantastic progress which we wish to share and celebrate with our collaborators.

This photo is taken on 29 April 2021. Top (left to right): Sophie O’Haire, Fanny Franchini, Nina Afshar, Koen Degeling, Maarten IJzerman, Olivia Rowan. Sitting: Riccarda Peters, Karen Trapani and Martin Vu. Nesha Nanu, Amanda Pereira-Salgado, Jenn Soon, William Wong, Sven Relijveld and Grace Chazan are not in the photo.

In the three years of our existence, we have, facilitated and supported by Olivia Rowan and Nesha Nanu, developed successful partnerships and collaborations with many groups across the VCCC partners. In 2020, a few people (Piers, Nancy, Rob and Julia) have left our group but we have also welcomed several new people. Our team now has 15 people (staff and students) and we are still recruiting for several projects. We are a very talented multidisciplinary team with backgrounds in data science, medical oncology, public health, simulation modelling and health economics. Although many of us have worked from home for the most part in 2020 and 2021, we can share several highlights.

Predicting the Health Economic Impact of Cancer Treatments (PRIMCAT)

In 2020, we were awarded the PRIMCAT project (Medical Research Future Fund) in a collaboration with the University of New South Wales, WEHI, Melbourne Institute, Peter MacCallum Cancer Centre and University of Adelaide. PRIMCAT (with 15 active researchers and managed by our fabulous Karen Trapani) aims to provide information about new cancer treatments likely to be listed in the next five years, including their budget implications for the Australian Commonwealth. This information, using cancer incidence and prevalence based on disease stage and patient demographics, will equip Australian HTA agencies and the applicants to forecast the population health economic impact of approved cancer treatments, expediting decision making and facilitating faster access to new treatments for Australian cancer patients.

PRIMCAT will be at the forefront of next generation cancer treatments. The cancer treatment landscape has changed and will continue to change substantially with the introduction of new targeted treatments and checkpoint inhibitors. The number of new treatments considered for reimbursement annually is growing every year and continued growth is expected. The share of anti-cancer drugs in the development pipeline is steadily growing to >35% of the cancer budget and new treatments are further shifting the treatment opportunities. Sophie O’Haire is leading work to estimate the prevalence of pan-cancer mutations such as NTRK and MSI which is required to predict update of new histology independent drugs, which is a part of her PhD (she won a 2021 PMCC scholarship!) supervised by Maarten, Jayesh Desai and Stephen Fox. The clinical fellows Marliese Alexander, Richard To and Jenn Soon (who also has enrolled as a PhD student in our group, co-supervised by Grant McArthur, Maarten and Fanny), lead the horizon scanning and treatment mapping studies for three nominated cancers. Further, our team has world-leading clinical experts and an international advisory panel to ensure the epidemiological estimates are validated internationally and thus have the high-quality input essential to deliver outcomes as projected. Further, the Health Policy Advisory Panel (HPAP) has been established to facilitate stakeholder engagement with the Department of Health in Canberra and representatives of the MBAC and PBAC Secretariats, ensuring our research team has access to relevant policy and process information. PRIMCAT will engage with the community by including consumer representation in our research program. Under the leadership of the Chair of the VCCC Cancer Consumer Advisory Committee, we will bring the consumer voice to our research.

COVID-19 and Cancer Policy

Early in 2020, just after the start of COVID-19, there were several indications of fewer cancer diagnoses as a result of global lockdown measures. The first indications of this came from the UK and the Netherlands. With this observation our group has implemented an inverse stage-shift model, assuming diagnostic delays would lead to stage progression and thus poorer survival outcomes. The modelling work, featuring our new Head of School Nancy Baxter and led by our rising-star Award winner Koen Degeling, has attracted interest and follow-up work with public policy research teams in the Netherlands and Canada. A second major achievement was realised by, Grace Chazan, who has led two large international surveys about changes in clinical management as a result of COVID-19 in a project co-supervised by Ben Solomon and Marliese Alexander.

Finally, we were involved in a project with Cancer Australia through a collaboration with Adam Elshaug, who commenced in Melbourne late last year (so pleased to work together, Adam!). In the project, with Fanny, Koen and Maarten, we estimated potential cost-savings from implementing lung cancer screening. The results are used to inform the Minister of Health about the implementation of lung cancer screening in Australia.

Building the data infrastructure: requesting large data requests

In 2020, we have made significant progress toward requesting and using clinical and linked data registries. We are so privileged to have been connected to Sallie Pearson (UNSW) and 2020 was the year we built a true friendship. Fanny Franchini and Karen Trapani, together with Sallie, prepared and submitted a large data request to the Victorian Centre for Data-Linkage (VCDL) spanning 10 years of administrative data for several cancer streams, linked to MBS and PBS service items.

We also have several other projects involving big data requests, including the Thoracic Malignancies or AURORA Cohort which is a collaboration with Peter MacCallum Cancer Centre. And Grace Chazan has extended the work to Flatiron in the USA, allowing detailed treatment information in large cohorts of ALK oncogene driven Lung cancer. Martin Vu and Koen Degeling, together with Melbourne Genomics, Jayesh Desai and Sophie O’Haire, have been able to request linked PBS and MBS data for the MGHA iPREDICT flagship cohort allowing health economics analysis of complex genomics sequencing in refractory cancers. In 2020, we also established our first linked-data registry for Colorectal Cancer patients as part of the Victorian Cancer Agency project about disparities in outcomes and resource use. This linked data set includes data from primary care (NPS and Patron), three hospitals and clinical data from ACCORD. In this project as well as in a second linked data-project in lung cancer, is an ongoing collaboration with Jon Emery’s Cancer in Primary Care group and the VCCC Data-Hub managed by Chris Kearney and it is one of the first examples demonstrating the strength of data-linkage through the Biogrid platform. In our group, Nina Afshar has been working on the linked data to analyse disparities in outcomes and health service utilisation between disadvantaged and less disadvantaged people. The same dataset is used by Sven Relijveld, Fanny and Michelle Tew to test methods of process mining for the identification of unique treatment pathways and the analysis of clinical practice variation.

The Illumina – UoM Partnership: the Health Economics Genomics Platform

In 2020, we established the Health Economics Platform in the Illumina – University of Melbourne partnership under the leadership of Sean Grimmond. The background for the platform is that the current funding landscape for disruptive technologies, like genomics, and the methods used to list new diagnostic tests for public funding, is challenged globally. In our health economics platform we therefore develop the capacity and expertise to demonstrate the value of complex genomic testing in managing cancer. In the platform we are leveraging the real-world data-infrastructure and use linked-data sets (clinical, genomics and financial) to (a) investigate the health economics and health service implications of cancer genomics and (b) to provide the evidence to support market and patient access in Australasia. Initially, two projects are defined investigating (a) the use of Whole-Genome Sequencing in selected blood cancers and (b) the development and clinical use of liquid biopsies in cancer management. Martin Vu leads one important project about the budget implications if Whole-Genome Sequencing would replace standard of care diagnostics (cytology / cytogenetics) in Acute-Lymphatic Leukemia, knowing the diagnostic yield of WGS is higher. This work follows from earlier studies on Bone Marrow Failure and Additional Findings, published in Genetics in Medicine. We also organised a large invitational symposium (29 October 2020) about the clinical translation of liquid biopsies, which is published in the journal “Diagnostics”. Results of the workshop have been published in opinion pieces in “Pursuit” and in the “Medical Journal of Australia”. Following from this workshop and choices made in 2020, we further invest in liquid biopsies, particularly ctDNA. Richard To, co-supervised by Koen and Jeanne Tie, has submitted a modelling study using ctDNA to de-escalate systemic adjuvant treatment in Colorectal Cancer. William Wong, a medical student supervised by Maarten and Stephen Wong at PMCC has commenced a review of the clinical impact of blood tests for pan-cancer detection and we will soon welcome a new PhD student in our group to work on liquid biopsies. We are also recruiting two research fellows and a researchassistant to leverage the work in the Health Economics platform.

PRECEPT: Simulation Models and Patient Preferences for Prostate Cancer

In the PRECEPT project, started in 2019, is a study we aim to develop a simulation model to analyse if new biomarkers such as ctDNA can support treatment decisions in localised prostate cancer. We are pleased to report several high-impact papers coming out of this project. A systematic review has been published in European Urology open science reviewing the evidence of tissue and liquid (urine) biopsies to inform treatment decisions in localised prostate cancer. Koen Degeling also led the PRECEPT simulation modelling studies, aiming at identifying the health economic benefit of treatment selection informed through new biomarkers. A first study, accepted in Value in Health, compares long term outcomes of three initial treatment options (surgery, active surveillance and radiotherapy) which forms the basis of a simulation modelling study to estimate the health economic benefit of new biomarker guided management strategies. PRECEPT is the first project where we systematically collect patient preferences, which emerged from our work with the VCCC consumer and engagement committee. Riccarda Peters leads the patient-preference studies investigating how biomarker information can support consumers making treatment decisions. A review about patient preference research is about to be submitted and two new patient preference studies using Discrete-Choice Experiment methods are planned. Riccarda is now a member of the University of Melbourne Discrete-Choice Experiments working group (led by Jemimah and Ilias) which will further strengthen capacity and expertise.

Clinical trials

In 2020 we finished two interesting projects about clinical trials participation in Victoria. Funded through the VCCC “clinical trial metrics” project we developed an online tool to determine the relative value of clinical trials based on multi-criteria decision analysis methodology. This information would support clinical trial units managing a portfolio.  The clinical trial value application is now being validated using clinical trials in brain cancer.

Thank you, funders and collaborators

We are most thankful to our collaborators and funders, who initiated and supported us throughout the last three years. Obviously, the VCCC and the University of Melbourne who had the vision to start this group. The Medical Research Future Fund (MRFF). Illumina and Melbourne Genomics Health Alliance for providing the resources to tap into the world of cancer genomics, MOVEMBER for funding the PRECEPT project and the Department of Health for funding a program of work on disparities in cancer survivorship with the Cancer Survivorship Centre at PMCC.

Looking forward

In the coming year we are excited about building on our success of the past three years by continuing our work on these significant projects detailed above as well as identifying new opportunities to further increase our impact to improve the care for cancer patients and contribute to a sustainable health system. We are looking forward to welcome new people, in particular Bishma Jayathilaka, Chief Pharmacy Information Officer at PMCC, who has just been accepted for her PhD studies working on prediction and monitoring of IO related adverse events; and hopefully we can announce continued funding through one of the MRFF or NHMRC grants we are involved in. Some of these grants will open new opportunities for collaboration with other partners, such as the Doherty Institute. Next year we expect to report more progress in the Illumina-University of Melbourne partnership and the PRIMCAT project. And also about the launch of the new programs within the Victorian Comprehensive Cancer Centre, particularly the Value-Based Healthcare and Data-Linkage programs.

The Cancer Health Services Research group was established as part of the VCCC strategy to develop capacity in data-driven cancer health services research and is embedded in the University of Melbourne Centre for Cancer Research UMCCR) and the Centre for Health Policy in the University of Melbourne School of Population and Global Health (MSPGH). The group is based on level 13 in the VCCC building.

Publications from our group

  1. Degeling K, Pereira-Salgado A, Corcoran NM, Boutros PC, Kuhn P, IJzerman MJ. Health Economic Evidence for Liquid- and Tissue-based Molecular Tests that Inform Decisions on Prostate Biopsies and Treatment of Localised Prostate Cancer: A Systematic Review. European Urology Open Science. European Association of Urology; 2021 Mar 26;27:77–87.
  2. Mahar RK, McGuinness MB, Chakraborty B, Carlin JB, IJzerman MJ, Simpson JA. A scoping review of studies using observational data to optimise dynamic treatment regimens. BMC Med Res Methodol. 2021 Feb 22;21(1):39.
  3. Degeling K, Baxter NN, Emery J, Jenkins MA, Franchini F, Gibbs P, Solomon B, Mc Arthur G, IJzerman MJ. An inverse stage-shift model to estimate the excess mortality and health economic impact of delayed access to cancer services due to the COVID-19 pandemic. Asia Pac J Clin Oncol. 2021 Feb 10.
  4. IJzerman MJ, de Boer J, Azad A, Degeling K, Geoghegan J, Hewitt C, et al. Towards Routine Implementation of Liquid Biopsies in Cancer Management: It Is Always Too Early, until Suddenly It Is Too Late. Diagnostics (Basel). 2021 Jan 11;11(1).
  5. Chazan G, Franchini F, Alexander M, Banerjee S, Mileshkin L, Blinman P, et al. Impact of COVID-19 on cancer service delivery: results from an international survey of oncology clinicians. ESMO Open. 2020 Dec;5(6):e001090.
  6. Vu M, Degeling K, Martyn M, Lynch E, Chong B, Gaff C, et al. Evaluating the resource implications of different service delivery models for offering additional genomic findings. Genet Med. 2020 Nov 20;93:631.
  7. Degeling K, Wong H-L, Koffijberg H, Jalali A, Shapiro J, Kosmider S, et al. Simulating Progression-Free and Overall Survival for First-Line Doublet Chemotherapy With or Without Bevacizumab in Metastatic Colorectal Cancer Patients Based on Real-World Registry Data. Pharmacoeconomics. 2020 Nov;38(11):1263–75.
  8. Degeling K, Vu M, Koffijberg H, Wong H-L, Koopman M, Gibbs P, IJzerman MJ. Health Economic Models for Metastatic Colorectal Cancer: A Methodological Review. Pharmacoeconomics. 2020 Jul;38(7):683–713.
  9. Franchini F, Degeling K, Pereira-Salgado A, Ben Tran, Au-Yeung G, McArthur GA, Solomon B, IJzerman MJ. Do assumptions in health economic evaluations hamper drug uptake? Journal of Clinical Oncology. American Society of Clinical Oncology; 2020 May 25;38(15 supplement):e19289–9.
  10. Pereira-Salgado A, Kwan EM, Tran B, Gibbs P, de Bono J, IJzerman MJ. Systematic Review of Efficacy and Health Economic Implications of Real-world Treatment Sequencing in Prostate Cancer: Where Do the Newer Agents Enzalutamide and Abiraterone Fit in? European Urology Focus. 2020 Apr 6;18(15_suppl):457.