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A farewell from David

Radiation oncologist Professor David Ball retired from practice in 2020. He was Director of the multidisciplinary Lung Service at Peter Mac.

As a former chair and member of the Cancer Australia’s Lung Cancer Advisory Group, David has spent his career both caring for lung cancer patients and advocating for improvements in lung cancer care delivery. David was chair of the Lung Cancer 2014 Summit Clinical Working Party, and co-chair of the repeat Lung Cancer 2019 Summit.

I'm interested in lung cancer still, but I'm not religiously following the literature. I enjoy reading, music and the arts – all the things I've not been able to do because [there’s] been such an explosion of information [in lung cancer care] and just keeping up with the literature has been a full-time job.

I was appointed to head of the Peter Mac lung cancer service back in 1981. When I started in that role, lung cancer was one of the worst cancers to have – the five-year survival was about 8%. It was one of the cancers that they say gave cancer a bad name.

There was very little that was thought could be done for the disease at that time. We had no CT scanners, we had no drugs that were effective and the only treatment that was available then, apart from palliative treatments, was surgery. Now, we have five-year survival exceeding 20% – that's a doubling of survival in my career. We've seen the introduction of CT scanners [and] PET scanning become an important part of our treatment. We have new drug treatments.

Most recently [we've witnessed] the development of immunotherapy, which [is] a very important advance. So it's been a great journey for me professionally to see these developments, and to know that the work that we've done at Peter Mac and trials across Victoria and Australia have contributed to world knowledge about better treatments and better care for our patients. But there is clearly a lot of work still to be done. It’s not just finding new treatments. It’s also doing the health services research, to ensure that new diagnostic procedures and treatments get rolled out. It became very clear at the lung cancer summits that it is no good having these fantastic advances unless you take the next step and ensure they are available widely and equitably.

Personally, I've always felt the importance of not only optimising my clinical skills, but also being an advocate for patients with the disease. When Paul Mitchell rang me and said, ‘Would you like to chair the lung cancer summit?’ that he was setting up, I leapt at the opportunity because I feel very strongly that this is a group of [cancer patients] who don't have a lot of people speaking out for them. They're relatively shy and embarrassed because of the association with smoking and resulting stigma, and who are facing a difficult disease in terms of not only the morbidity and mortality, but also what can be demanding treatments. I found it very gratifying to see things improve as they have – not just from better treatments but also more personalised delivery, less toxicity and a more multidisciplinary approach.

I remember going to a COSA Annual Scientific Meeting years ago and there would be, for example, the breast and lung interest groups meeting concurrently in adjacent rooms. In the lung room you would have had maybe half a dozen people and next door at the breast meeting, it would be overflowing – standing room only.

That wouldn't be the case now. You’d still have a lot of people in the breast cancer room but you would certainly have a lot of people in the lung cancer room to hear the presentations as well. The [lung cancer] summits have brought together a fantastic number of people – the last lung cancer [2019] summit was, I believe, the best attended of all the summits, and it was great to see consumers and our allied health colleagues there as well.

One thing that I would emphasise is the great difficulty some patients have in getting into the lung cancer care system in a timely manner. Having heard from GPs who attended the last lung cancer summit, most GPs are aware of a breast specialist nurse in their area. They ring the nurse, who will then triage and help navigate referral to a multidisciplinary meeting or specialist associated with an MDM. But for lung cancer nurses and coordinators there is virtually no funding at all, so there are very few of them. For a complex disease, which requires involvement by so many different specialists and allied health support, it seems to me that a lung cancer nurse or coordinator is a critical person [to be part of the team].

We have to remember this is a very difficult disease to treat. Unlike breast, prostate, bowel and melanoma, in which the disease is usually localised at diagnosis, in lung cancer, half of the patients will have metastatic disease when diagnosed. So, the treatment is often less clear cut, usually involving multiple treatment modalities, and with a less comprehensive and robust scientific evidence base.

We learned from the summits just how passionate the lung oncology community is about getting the best outcomes for their patients. A lot of us take home our anxieties about our patients, who have seemingly intractable problems. And, you're sort of scratching your head, 'What can I do for this person?' The multidisciplinary team and summits have allowed us to share these stresses, but even so, the rate of burnout within oncology teams remains high.

When I retired, what I really missed were the camaraderie and mutual support of the multidisciplinary team, but also the patient interaction, especially those very grateful patients with whom you’ve really formed very long relationships. One young woman was in her mid-thirties when we first treated her, and she's still alive and well and functioning normally over ten years later, which would have been unheard of when I first started in this line of work. That's a great reward.

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