Michael Barton, OAM, is professor of radiation oncology at the University of New South Wales. He is also research director of the Collaboration for Cancer Outcomes Research and Evaluation and research director of the Ingham Institute of Applied Medical Research at Liverpool Hospital.
I studied ancient history and Latin at school, and not much science, which is not a very good preparation for a medical career, perhaps. I don’t think I had any driving desire to cure people. I was interested in how the body works and in diseases. I didn’t have an evangelical drive. What I really liked about oncology was that it required a logical decision process, which appealed to my academic and slightly formal mind. I am interested in improving outcomes by applying, and increasing access to, best practice.
Shortly after I started as a radiation oncology registrar trainee at Prince Alfred, one of the two treatment machines caught on fi re. It was as old as I was. The replacement machine had been sitting in boxes, in storage, for about a year and had run out of warranty. The hospital hadn’t installed it because it was a stronger machine and so the bunker housing it needed extra shielding. That failure to invest in effective resources left a marked impression on me. It was symptomatic of the general underresourcing of cancer services at that time.
Fairly early in my career, I spent time in Toronto looking at the effect of interrupting treatment in people with laryngeal cancer. It was at a time when we gave people a few days off treatment so their throat would feel better, but we discovered that each day you delay treatment you lost 1%–2% of the benefit. It was a study of more than 1000 cases of treatment over 20 years. That experience taught me how much valuable information there was in the records we had already collected. That work has subtly improved outcomes. Nowadays, if anyone has an interruption in treatment, we compensate for it.
When I returned to Australia I became interested in the cancer education we were giving young doctors, because it seemed a haphazard business. A lot of university courses were going through changes and I was in charge of the Sydney Uni graduate entry program’s cancer block. So we had this need around the country to say, “If you’ve got 6 weeks, what should you be teaching?”.
Working with the Cancer Council Australia, I chaired the Oncology Education Committee, which produced the “Ideal Oncology Curriculum”. It is used as a checklist for cancer teaching and has been incorporated to some extent in most medical courses around the country. The Union for International Cancer Control endorsed it and it was translated it into a number of different languages, including Icelandic. It’s widely known around the world.
One of my biggest achievements remains the “Basic Science of Oncology” course. I wanted to give an introduction to a broad range of sciences, to improve oncology training. Most trainees in oncology in NSW have done the face-to-face course, which has been running for 20 years. We turned it into a distance learning course on CD ROM — 80 hours of interactive animation. It’s also online and has been downloaded more than 2000 times.
That project involved 55 authors and it took nearly 10 years to complete. There’s a growing appreciation that radiotherapy is one of the cheapest forms of cancer treatments. I spend a lot of time trying to make the case in language that administrators and treasury understand. Understanding the perspective of people who fund these things, and conducting feasibility studies, was part of how I helped to achieve radiation oncology facilities in the Northern Territory and New Guinea and, hopefully, will achieve them soon in Tasmania. It’s also helped to achieve $51 million in federal funding for new research facilities at the Ingham Institute.
While we use computed tomography scans routinely in radiotherapy, the next step is to introduce magnetic resonance imaging (MRI). We’re installing an MRI scanner and linear accelerator in the same room, which will enable us to monitor treatment every day and do functional targeting, so we’re able to treat the most malignant areas. It will be one of the world’s first MRI-guided linear accelerators.
I only treat brains and lymphoma in the Cancer Therapy Centre at Liverpool. I led the development of the cancer practice guidelines for adult glioma. I’ve also reviewed cancer services in NSW and Western Australia and created the framework for Victorian cancer services. It was part of the reform of services, which included the recommendation that the Peter MacCallum Cancer Centre should move to the Royal Melbourne Hospital’s Parkville campus. That has recently been funded to the tune of $800 million.