Introducing the Centre for Cancer Research
The University of Auckland is home to more than 300 cancer researchers in areas ranging from tumour biology to drug discovery to palliative care. Until recently, however, people tended to work in their disciplinary silos with familiar partners. Now a new research centre is bringing together people and organisations to improve cancer care across Aotearoa New Zealand.
Te Aka Mātauranga Matepukupuku (Te Aka) is the largest cancer research centre in the country in terms of the number of researchers involved. It aims to support and enhance cancer research by encouraging researchers to collaborate across disciplines and with patients and clinicians. It also aims to foster and deepen relationships with district health boards (DHBs) as well as with clinical, philanthropic, community and industry organisations.
Longer term, the Te Aka aims to work with clinical partners to develop an integrated or comprehensive cancer centre where patients, clinicians and researchers can interact in a physical environment that delivers superior care to patients, supports their families and advances cutting-edge research.
“Cancer affects nearly all of us,” says Andrew Shelling, who is Associate Dean (Research) at the Faculty of Medical and Health Sciences and one of the four directors of the Te Aka. “Between one in three and one in two of us will get cancer in our lifetimes. Many of us will die with cancer and some of us will die of cancer. The whole point of life-changing research in this area is to make the latter less common.”
“We want to improve outcomes for all New Zealanders affected by cancer and their whānau,” says Peter Browett, another of the Te Aka directors, who is also Professor of Molecular Medicine and Pathology and consultant haematologist at Auckland City Hospital. “Specifically, we want to address issues of inequity in all areas of the cancer pathway from prevention strategies to diagnosis, treatment and outcome.”
A focus on health equity
Though cancer doesn’t discriminate, inequities woven into the fabric of society result in inquitable cancer outcomes. Recent research has shown that Māori are twice as likely to die from cancer as non-Māori. In fact, life expectancy is seven years shorter for Māori than for non-Māori.
“Māori don’t live seven years less than non-Māori because of some fluke of genetics. It’s because of how our society is set up,” says George Laking (Te Whakatōhea), who is Manutaki Haumanu Māori (Clinical Director Māori) of the Te Aka. Laking also has a similar role in Māori health with the Auckland District Health Board as well as being a medical oncologist and honourary University of Auckland academic. “Equity is about remedying uneven outcomes in health and wellbeing that are avoidable and unjust.”
Inequities exist along every step of the cancer journey, says Leesa Russell, project manager for Te Aka.
“The Waitangi Tribunal Health Services and Outcomes Inquiry found that the health system as a whole is inequitable for Māori. When it comes to cancer, Māori access services less, feel less comfortable in the environment, and tend to be diagnosed later, when the cancer is worse.”
These inequities extend to research. At Te Aka, only four percent of members are Māori, though Māori make up nearly 17 percent of the population. That’s why one of the centre’s goals is to develop Māori cancer clinicians and researchers in particular as part of a broader mandate to train future leaders in cancer research and treatment.
In addition to improving equity, Crown entities, including universities and district health boards (DHBs), must honour their obligations to Te Tiriti o Waitangi, the Treaty of Waitangi, says Laking.
“A large part of what Te Tiriti is about is maximising the wellbeing and success of Māori in the context of living in a land that’s shared with the Crown. Historically, the Crown has failed to live up to its obligations, and that applies in the field of cancer, so it’s about time that our institutions of higher learning applied an equity lens and a Te Tiriti lens to all their work.”
Pacific peoples also face health inequities and have a higher cancer death rate than the general population. Te Aka is starting to engage with Māori and Pacific organisations to build positive relationships with the communities they serve.
Another focus is gender equity. By applying a gender lens to its research grants, the Centre is helping female and non-binary researchers, particularly up-and-coming ones, to make their mark in a range of areas including endometrial cancer research and the impact of nutrition on childhood cancer.
A lengthy building process
The idea of bringing together the University’s cancer researchers has been brewing for many years. Megan Putterill, another of the centre’s directors, has been working towards creating Te Aka for the best part of a decade.
Putterill is Strategic Development Manager for the Faculty of Medical and Health Sciences and the Auckland Academic Health Alliance, which links the University of Auckland with Auckland’s three DHBs for research, teaching and clinical delivery purposes. She helped launch the entities that form some of the building blocks of Te Aka – Grafton Clinical Genomics, a genomics lab largely focused on cancer research; the Auckland Cancer Trials Centre, an early-phase clinical research facility dedicated to providing patients access to novel anticancer therapies; and Te Ira Kāwai | Auckland Regional Biobank, which collects tissue samples and relevant clinical information donated by patients to support ethically approved medical research.
“A lot of groundwork needed to be laid. Doing it under the auspices of the Auckland Academic Health Alliance gave us the mandate to work very closely with the Auckland DHBs,” says Putterill. “Though the Centre for Cancer Research is in its early days as a formal entity, it’s based on a lot of deep and productive relationships. There’s nothing else with its scope and scale in New Zealand.”
Headquartered at New Zealand’s largest university, in its largest and most diverse city, Te Aka has the critical mass of researchers and patients to set the pace for cancer research nationally and to make an impact internationally. Its researchers have strong links with researchers and clinicians across the country and the world. This helps link research and practice.
“Researchers are often aware of the ways to answer research questions but may not be aware what the clinical question is. Clinicians are aware of the question but may not know how to answer it,” says Browett. “By working together, we can make research relevant and immediately applicable.”
Cutting-edge Te Aka research is already helping patients through cancer genomics and personalised medicine. In addition to his mahi as a Te Aka director, Browett co-leads a group sequencing individual patients’ blood cancer genes to work out how best to treat them given the specific mutations that led to their cancers. Other researchers are applying genomics to solid tumours. Te Aka members are also internationally recognised in areas including population health, epidemiology and drug discovery.
Currently, Te Aka is a virtual entity within the Faculty of Medical and Health Sciences but it is in the process of applying to be recognised as a university-wide research centre. Its future ambitions are even bigger.
In the short term, the centre is working with Te Aho o Te Kahu | Cancer Control Agency on building national cancer data sharing infrastructure. That project will bring together about 40 researchers who work on large data sets.
Within a few years, Te Aka aims to establish itself as a national Centre of Research Excellence, New Zealand’s first such centre in cancer research. To accomplish this, it is working to build and formalise collaborative relationships and structures across the country.
Longer term, Te Aka would like to build a bricks-and-mortar facility, tentatively called the Integrated or Comprehensive Cancer Centre, that will bring together over 100 of its researchers in a space near the Auckland City Hospital where they can work directly with clinicians, cancer patients and patients’ whānau.
The other two-thirds of Te Aka’s members will continue to be linked virtually, as is appropriate for non-clinical researchers in areas such as cancer health economics, cancer prevention and health policy.
Through its transdisciplinary, inter-institutional work, the Centre for Cancer Research aims to improve cancer care, treatment and prevention for individuals, whānau and communities across Aotearoa New Zealand, now and into the future.
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