Ontario Cancer Institute

Ontario Cancer Institute: Successes and Reverses at Sherbourne Street

E.A. McCULLOCH
https://www.jstor.org/stable/j.ctt80n3w
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    Ontario Cancer Institute
    Book Description:

    To achieve this goal the institute divided its operation into four strands: two of the strands were the research areas - the study of advanced radiation therapy and biology, which worked separatively but cooperatively; a third was patient care; and the fourth element was leadership, provided by the clinical chiefs, the heads of the research divisions, and the administration, in particular the institute's first administrator, John Law. Together these strands helped create a philosophy that made the Ontario Cancer Institute unique and provided the basis for its national and international success. Essential to these successes was a new graduate department, Medical Biophysics, based in the University of Toronto School of Graduate Studies. This department, which provided an innovative, research-based doctoral and masters program, meant that the OCI could accurately be described as a centre for cancer treatment, research, and education. McCulloch describes how the first quantitative assay for stem cells played a major role in bringing OCI research to the international stage as well as influencing other science and much of the clinical thinking in the Institute. Other major advances that brought international recognition have been the identification of the mechanisms that allow cancer cells to resist death from the effects of a variety of different tumours and the isolation of the gene that encodes the T cell receptor, a critical part of the immune apparatus for dealing with foreign cells and viruses. McCulloch also details how lack of space to meet growing demands was a continuing source of frustration and disagreement, and how sometimes serious interpersonal problems hindered the forward thrust of development. Describing these events as well as institute's successes, he provides an insight into the history of Canada's premier cancer research centre.

    eISBN: 978-0-7735-7094-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-2)
  4. Beginnings
    (pp. 3-20)

    Cancer is an ancient, often fatal disease, affecting most multi-cellular animals. For many humans, the thought of cancer is particularly distressing. When cancer is diagnosed the patient’s response may be not only fear but despair. The facts support a different view. Often cancer can be cured by surgery, radiotherapy, drug treatments, or other methods. Even when the disease is not controllable, many of its manifestations, including pain, can be managed effectively. It follows that cancer treatment facilities are highly prized.

    Cancer treatment is based firmly on research results obtained over the last century. The disease begins as a genetic change...

  5. First Research Programs
    (pp. 21-31)

    The staff in the two research divisions began work in 1957, as soon as they had unpacked their apparatus and assembled supplies. Their first programs reflected both the ideas they brought to the oci and the priorities flowing from its goals.

    The work in the Physics Division followed two lines. Clinical physics was closely linked to radiation oncology. Isotope-based radiation therapy machines were just coming into common use, based on Harold Johns’s discovery that ⁶⁰Co could be engineered into apparatus suitable for clinical use – the “cobalt bomb” of popular language. His personal research was directed toward a further exploitation...

  6. Leadership and Style
    (pp. 32-45)

    The Ontario Cancer Institute was not a democracy. Its leaders were given great powers in such important areas as appointments, review, space allocation, and salaries. The management style was not that of an oligarchy; instead, individual staff members in both research and clinical services felt that they were in control of their own destinies. Without being stated, each understood that success would be rewarded and failure tolerated only within narrow limits. The director, Cliff Ash, concentrated his attention on his own area, radiation oncology. The chiefs of departments and divisions were given only very general direction. They conferred either one-on-...

  7. Normal and Malignant Stem Cells
    (pp. 46-60)

    From 1960 on stem cells became a major research theme at the Ontario Cancer Institute. Stem cells are important because many adult tissues consist principally of short-lived cells that must be replaced continuously. Stem cells are long-lived and their growth capacity allows them to be the source of new functional cells with limited life spans.

    A stem cell may divide, giving rise to two new stem cells. Alternatively, stem cells may undergo a change that results in reduced growth potential and the initiation of the series of events that lead to functional cells. This change is called differentiation. Blood cell...

  8. Growth and Change
    (pp. 61-70)

    From the beginning, the oci was successful in both patient care and research. But success always makes demands, and it was soon clear that the building was too small. The new cancer patients seen each year greatly exceeded the three thousand for which the facilities were planned. Success in the research divisions could only continue if more space was provided. In 1965 planning began for a major expansion that would increase in-patient beds by fifty-five, including fifteen for children and twelve for clinical investigation. Out-patient facilities were also to be enlarged. An expansion of research space would be funded by...

  9. Immunology and Hematology Using Cell Culture Methods
    (pp. 71-84)

    Lou Siminovitch, while head of Biological Research, led his division at a time of dramatic change in science. His interest in genetics made it easy for him to understand the importance of the emerging concepts of biological information. His participation in the spleen colony work had convinced him of the value of the blood and lymphoid systems as models for probing such basic cell functions as growth and differentiation. His understanding was the basis for the priority given to immunology and hematology. When Till became head of Biological Research, he retained these priorities.

    Advances in molecular biology caused a revolution...

  10. Physics and Radiation Therapy
    (pp. 85-97)

    The Division of Physics and Radiation Therapy (later called Radiation Oncology) enjoyed a synergistic partnership. The clinical physics group provided essential support for therapy by measuring doses, calibrating machines, and servicing equipment. Scientists in the Physics Division often found their research goals in the problems of the therapists; these, for their part, looked to research results as sources for clinical innovation.

    Harold Johns’s key faculty in Physics, Gordon Whitmore, Robert Bruce, John Hunt, Jack Cunningham and, after 1965, Mike Rauth, provided stability, since they spent their careers in the division, sometimes with interruptions. Jim Till, an original member, transferred to...

  11. The Middle Years, 1971–1981
    (pp. 98-109)

    By 1971, thirteen years after its formal opening, the oci/pmh was recognized nationally and international as an excellent centre for cancer care and research. For the clinical role, the pattern of patient referral was well established. About 50 percent of patients came from Toronto and its immediate suburbs. The rest were referred from northern and central Ontario. These regions required additional service; small teams of radiotherapists and medical oncologists paid periodic visits. These peripheral clinics spared patients the need to come to Toronto and helped in the follow-up of those who had been treated and returned to their homes.

    The...

  12. Interface Research
    (pp. 110-122)

    The proper size of oci research was a matter of debate. Till and Johns, the heads of the research divisions, told the 1972 role study consultants that critical mass had been achieved and further growth would be detrimental. McCulloch, with his responsibility for research in the Medical Department, was convinced that more resources of people and space were required. To make his case, he used the term “interface research” to describe laboratory work that had a direct application to clinical problems. This terminology, stressing the close relationship between laboratory and clinical research, seemed fresher than the usual “bench-to-bedside” language that...

  13. The Style of Ray Bush as Director
    (pp. 123-140)

    John Darte was director for only six months before his sudden death. It is remarkable that in that short time, his personality made a lasting mark, particularly because of his intent to move the institute further toward the centre of cancer care delivery. Ray Bush succeeded him in 1976 and was director of the oci for twelve, often turbulent years.

    John Law had retired as administrator in 1974 and was succeeded by his assistant, Garth Hayley. John Law’s influence had established the office of administrator as a close collaborator, almost an equal, with the director. Bush did nothing to change...

  14. Response to the Crisis of Space and Equipment
    (pp. 141-154)

    In 1983 the Ontario Cancer Institute celebrated its twenty-fifth birthday. The public was invited to an open house, where both clinical and research accomplishments were displayed. A club was formed for the members of the staff who had been active for the first quarter century. The leaders, especially the director, were well aware that in spite of the euphoria there was a very real problem. When the institute was first planned, it was expected that about three thousand new cancer patients would be seen each year. This number was soon exceeded, by 1983 the number was 6,555. The problem was...

  15. Preparing to Move
    (pp. 155-165)

    A search was initiated for a successor to Ray Bush. This time Clarke hired a professional search company, Caldwell and Partners, to find a new director. The search company narrowed the field to two candidates, both experienced in Hospital Administration. The choice was Don Carlow, who was then senior vice-president of the Winnipeg Health Science Centre. Although he had an md, Carlow’s work and interest were in the running of health facilities rather than in the direct delivery of care. Carlow was a man of slight stature; but there was nothing slight about his mind or his determination.* His first...

  16. Last Days on Sherbourne Street
    (pp. 166-172)

    The reorganization of the research and clinical divisions placed the Ontario Cancer Institute on a firm footing for its move. There remained obstacles, especially problems about money. Even in the final days, successful research provided opportunities that would greatly strengthen the oci on its new site.

    Until the decision was taken to build a new hospital, fund-raising had been passive. Donations were cheerfully accepted and retained in a parallel organization called the oci/pmh Trust. The trust was considered as the funding source of last resort, to be used for important purposes where money could not be obtained elsewhere. For example,...

  17. Glossary
    (pp. 173-178)
  18. Index
    (pp. 179-183)