International collaboration

Throughout 2010, the SPR project manager, A/Prof David Ellis and A/Prof Paul McKenzie engaged in discussion with Royal College of Pathologists UK (RCPath), College of American Pathologists (CAP) and the Canadian Partnership Against Cancer (CPAC) about closer collaboration. This resulted in the signing of a Memorandum of Understanding (MOU) with CAP mid 2010 (see Appendix D). Further discussion o the benefits of collaboration lead to a teleconference between all four parties in October 2010. This was quickly followed by a face to face meeting on Nov 14th 2010 in Chicago. On February 27th 2011 a meeting of all four international parties was held in conjunction with United States & Canadian Academy of Pathology (USCAP) meeting, in San Antonio, Texas. A formal “Agreement to Collaborate” document was put forward by the RCPA SPR representatives to the international team which in simple terms outlined the goals and steps required to deliver an outcome from the collaboration. The result was a very significant step forward with all four parties signing the agreement and agreeing to work towards the standardization of cancer core data, metadata, naming conventions and value lists for all cancers, beginning with prostate, endometrium, melanoma and lung. (Refer to Appendix E)
The ICCR team comprises:

1. The Royal College of Pathologists UK (RCPath) - represented by Dr Lynn Hirschowitz, Pathologist and Chair of the Working Group for Cancer Services and Prof Michael Wells, Pathologist and Chair of the Histopathology Specialty Advisory Committee.
2. The College of American Pathologists (CAP) - represented by Dr Mary Kay Washington, Chair, Cancer Committee
3. The Canadian Association of Pathologists (CAP-ACP) in association with the Canadian Partnership Against Cancer (CPAC) - represented by Prof John Srigley, Chair, National Pathology Standards Committee (CPAC)
4. The Royal College of Pathologists of Australasia (RCPA) - represented by A/Prof David Ellis; Pathologist Clinical lead, and Meagan Judge, Project Manager, Structured Pathology Reporting of Cancer project.

The ultimate goal of the collaboration is that cancer reports for all patients across the world will be of the same high quality content and format, underpinning cancer management at all levels, from individual patient care to international benchmarking and national cancer strategy.

Work on all four cancer datasets commenced in June 2011 with each country taking on the leadership of an international team working on the development of one cancer. The priority for each cancer specific team was to agree the elements which are CORE. CORE elements are those which are essential for the clinical management, staging or prognosis of the cancer. Core was later updated to REAQUIRED elements. Secondary to this aim was for each team to review and propose the value list or responses to the Required elements eg “present”, “not indicated” and then to establish a list of recommended elements. Assessment of evidence against the extended NH&MRC guidelines for evidence assessment (Merlin, T. et al) was part of the development process. Progress was assessed at a meeting of the ICCR at the August 2011 European Society of Pathologists (ESP) meeting in Helsinki.

The meeting of the ICCR in Helsinki was considered a ‘huge success’. Not only had all teams made significant progress but a number of important decisions were made as to how to proceed and a clear set of action items was developed including:

1. Preparation of a brief communiqué with key points to be used in communications, newsletters etc.
2. Preparation of a detailed report of the project (following normalisation of each approach)
3. Establishing a preferred and simplified process for further protocol development
4. Abstract submissions to USCAP, and to UICC 2012.
5. Submission of 4 cancer specific papers and one generic paper to lead clinical journals,
6. Further investigating and progressing our engagement with key International Cancer Organisations

Since the August meeting significant progress has been made:

• A format for the publication of the datasets was agreed and four draft international datasets have been developed – 2 are published to the following website:
  www.rcpa.edu.au/Publications/StructuredReporting/ICCR.htm
• The communiqué noted in point 1 above it also posted to the website, a second communiqué is in development
• The process for continued development has been agreed and is in being ‘tested’ through the work on the Kidney cancer dataset – see below for additional information.
• A publication on Endometrium Cancer has been completed and accepted for publication to the IJGP. Work on the Melanoma, lung and prostate articles has commenced.
• Harmonisation of terminology across the datasets has been an ongoing piece of work with significant progress being made.
• Seeking a long term governance model for the collaboration has also made significant progress and is described below:

The ICCR committee considered that the International Agency for Research on Cancer (IARC) was the best fit for work on international cancer datasets with their focus on cancer data. Looking at the organisational structure (http://www.iarc.fr/en/research-groups/org_chart.pdf) there are 2 groups of note: the Cancer Information (CIN) section which directs the collection of cancer data and hosts the IACR – International Association of Cancer Registries as well the section which manages the production of the WHO monographs (IARC Monographs (IMO)).

Calls with Helen Farrugia (Cancer Council Victoria) and David Roder (Cancer Australia, Cancer Council SA) were held and both agreed to recommend the project to David Forman head of the Cancer Information (CIN) section of IARC.

Ian Frazer, current Chairperson of the Scientific Advisory Council of IARC, was contacted at the recommendation of Ian Olver CEO, Cancer Australia. Ian was very supportive of the whole international cancer dataset idea and raised the matter with Chris Wild, Director of IARC.

A meeting was then held with Chris Wild, in Perth in November and he expressed great interest in the project and could see real opportunities in its implementation. The ICCR committee agreed to put forward a proposal to IARC that would include the completion (publication, open consult process) of the initial four cancer datasets under the IARC imprimatur as well as undertaking development of a new cancer dataset with an expanded ICCR to pilot the entire process. This proposal was developed and submitted to IARC for consideration. IARC have responded positively and a meeting in July with A/Prof David Ellis and Dr Chris Wild and David Forman of IARC is planned.

In order to expand the collaboration beyond the initial quadripartite group an approach to the European Society of Pathology (ESP) was made and has resulted in an invitation to present to the chairs of the working groups and advisory committee in Prague in September 2012.

As noted above, the ICCR agreed that the next cancer to be tackled internationally is kidney. This was considered an ideal choice in that it was a major point of discussion at the ISUP meeting in March in Vancouver and involvement of ISUP would make it a truly international effort. This process has commenced with the identification of an expert group; research on kidney datasets undertaken and meetings planned.

Regular calls with the ICCR are held to agree next steps, discuss issues and ascertain progress.