HUS COMPREHENSIVE CANCER CENTRE + Annual Report 2018 CONTENTS BOARD OF DIRECTORS AND TOP SCIENTISTS

3 Board of Directors and Top Scientists The 4–5 Foreword Comprehensive 6–7 Foreword Research Cancer Centre 8–11 Major Events in 2018 is strongly TREATMENT committed to 14–17 Radiation and Radioisotope , BNCT Johanna Mattson Panu Jaakkola Mauri Kouri Vuokko Kolhonen developing care 18–19 Solid Tumors Director, Research Director, Administrative Chief , Chief Officer 20–23 and Coagulation Disorders Adjunct Professor Professor Adjunct Professor quality and 24–25 Trial Unit treatment results. 26–27 Breast 28–29 Center 30 Rehabilitation 31 Medical Imaging 32–33 Pediatric Cancers 34–35 Nursing 36–37 Comprehensive Cancer Center in 2018

QUALITY AND PATIENT INVOLVEMENT Mikko Tenhunen Micaela Hernberg Ulla Wartiovaara-Kautto Marjut Leidenius 40–43 Quality and Patient Safety Head of Radiotherapy, Head of Solid Tumors, Head of Hematology, Head of Breast Surgery, 44–45 Patient Involvement Professor Adjunct Professor Adjunct Professor Professor 46–47 Patient Services

RESEARCH

Quality and 50–51 Research in Comprehensive Cancer Centre Patient Safety, 52–57 Research Groups pages 40–43 58–59 Key Projects and Funding

COOPERATION Kuva 62–63 iCAN 64–65 and the Biobank, FinnGen Tiina Saarto Sirpa Leppä Kimmo Porkka Riitta Lassila Head of Palliative Care Center, Head of Clinical Trial Unit, Professor, Professor, 66–67 FIMM Professor Professor Scientist Chief Physician 68–71 Cancer Biology

72–73 Cancer Genetics 74–79 Tumor Groups 80 FICAN South 81 Syöpäklinikan tuki ry

Resarch in Compre- EDUCATION henisive Cancer Centre, pages 50–51 84–85 Training for 86–87 Training for Nurses

Satu Mustjoki Heikki Joensuu Akseli Hemminki Katja Tähkä Professor, Professor, Professor, Quality Manager Chief Physician Scientific Advisor Scientist

3 FOREWORD Johanna Mattson

HIGH-QUALITY AND TIMELY CANCER Johanna Mattson TREATMENT Director, Adjunct Professor

HUS’s Comprehensive Cancer Centre is the larg- specializing in geriatric . Needs of young est and most versatile cancer center in Finland. We patients are met with developing occupation- infrastructure by setting up a data lake and a Despite this, the Center has been able to provide were the first in the Nordics and the second in Eu- al therapist services to coordinate support meas- biobank to attract even more partnerships with quality care without delay while keeping expenditure rope to be designated a Comprehensive Cancer Cen- ures. academia and private businesses. With the new growth moderate. The Comprehensive Cancer Cen- tre by the Organisation of European Cancer Insti- The Comprehensive Cancer Centre is strong- Apotti patient information system, the effective- tre will continue to act as both an international and tutes (OECI). ly committed to developing care quality and treat- ness of treatments and our treatment results can national leader and develop its operation to meet the In accordance with the CCC status, the Can- ment results, and we are currently preparing for be assessed in real time. growing demand. This goal is shared by all the 120 cer Centre offers cancer patients timely, high-qual- Joint Commission International (JCI) and Mag- The Center now uses radiotherapy equipment physicians, 400 nursing professionals, and 50 oth- ity, multi-professional cancer treatment. New can- net (nursing) accreditations. Use of Lean and methods that are among the most modern in er cancer treatment experts working at the Cent- cer treatments made possible by medical research methods, including daily management meetings, Europe. In 2019, these will be complemented with er, which guarantees that high-quality expertise is are a central factor in our operation. Our operation is widespread at Comprehensive Cancer Centre. the first neutron-producing accelerator suitable available for the treatment of all types of cancer. emphasizes a patient-oriented treatment culture. Cancer treatments are changing towards more for patient care. The accelerator will be utilized for All in all, we have every reason to be satisfied To support this, the Comprehensive Cancer Centre personalized therapies, and successful cancer re- boron neutron capture therapy (BNCT). With the with our development over the past few years. We started the first patient advisory board in Finland, search has a pivotal role in improving treatment BNCT device, the Comprehensive Cancer Centre can confidently look forward to 2022 when the new and patients can additionally participate in develop- results. In 2016, Comprehensive Cancer Centre is in a prime position to develop the new, promis- Bridge Hospital facilities will be finished providing ment as experts by experience. As an international started an early phase molecular research unit ing cancer therapy, and acquiring the accelerator new premises for the Comprehensive Cancer Cen- pioneer, the Comprehensive Cancer Centre has par- (Phase I), which operates within the Nordic Ear- to Comprehensive Cancer Centre is a great exam- tre as well. However, much remains to be done espe- ticipated in developing digital mobile services that ly Clinical Trial (NECT) network as well. In 2018, ple of what academic research can yield. cially for the cancers with the worst prognosis. The cover a cancer patient’s entire clinical pathway. The researchers at Comprehensive Cancer Centre pro- The constantly increasing number of new can- Comprehensive Cancer Centre has prepared for this services enable patients to report on and monitor duced over 250 publications. The number of pub- cer cases, improving treatments, and migration to work by participating in regional, national, and in- their own well-being. Elderly patients have been tak- lications has steadily increased since 2010. HUS larger cities are evident as Comprehensive Cancer ternational networks and investing in innovative en into consideration by starting an outpatient clinic has made significant investments in research Centre treats 5 to 10% more patients every year. corporate partnerships.

1936 1939 1954 1955 1963 1973 1976 1981 1988 1991 Department of Finland’s first First use of Finland’s first cobalt Finland’s first First linear First use of First autologous First use of 3D First allogeneic stem Oncology was megavoltage radioiodine therapy therapy device accelerators (betatrons), accelerator computer- stem cell treatment planning cell transplantation founded machine (with for thyroid cancer in Department of Oncology assisted treatment transplantation and from a registry radium, in use from Finland transferred to Meilahti planning first allogeneic stem donor 1939 to 1962) cell transplantation from a sibling

4 5 FOREWORD RESEARCH Kimmo Porkka

PERSONALIZED CANCER CARE AT THE Kimmo Porkka HUS COMPREHENSIVE Professor, Scientist CANCER CENTER

cient drug discovery and repurposing for individu- AI/deep machine learning algorithms to facilitate In cancer care, we are currently living a time of early phase clinical drug study center for efficient al patients, we have complemented molecular pro- treatment/trial matching and advanced home care transformation with novel, effective and relatively and rapid translation of research innovations in- filing by setting up a large-scale ex vivo drug test- with intelligent monitoring. HUS has heavily in- well-tolerated anti-cancer drugs being introduced to patient care. Consequently, the number of first- ing platform currently consisting of >500 antican- vested in this area with innovative PPP (public-pri- at an increasing pace every year. With the advent of in-man and Phase I-III studies is increasing as is cer compounds. This systems approach vate-partnerships) solutions, such as iCAN (digital- accessible and affordable molecular and function- the scientific output of the research talent at the developed in collaboration with research groups at precisioncancermedicine.fi) and CleverHealth eco- al profiling of each individual patient and tumor we Center, in line with our aim of being one of very top FIMM (Institute for Finland) system (cleverhealth.fi). are entering an era of truly personalized treatment Cancer Centers in Europe. has proven to be highly successful for preclinical The near future of cancer care and research for many patients. Besides targeting the malignant As outlined in the HUS strategy, we are current- drug research (collaborations with several major looks bright and HUS Comprehensive Cancer Cent- cells, we have learned to stimulate host immune re- ly expanding research and development by closely pharma companies ongoing), predictive biomark- er is well positioned as one of the leading Europe- sponses providing hope for a prolonged tumor re- engaging with our major stakeholders - university, er discovery and in novel an oncology/hematology centers to provide our pa- jection and cure. The combination of tumor target- pharma, biotech (local SMEs in particular), and pa- clinical trials. The systems precision medicine ap- tients with the best and uptodate care possible. ing and anti-tumor immunity restoration will hope- tient organizations. The funding resources are be- proach has been expanded to include lymphomas fully be the ultimate one-two punch against this ing diversified, with focus on larger EU and other and solid tumors using innovative organoid and deadly disease. major external grants. cancer-on-a-chip technologies. HUS Comprehensive Cancer Center has been in Due to ease of access to tumor tissue enabling We are already facing the challenges resulting the forefront of these developments both by engag- extensive and repeated sampling, hematological from the advancement of cancer medicine, treat- ing fruitful collaboration with basic and transla- cancers are particularly well characterized at deep ment complexity and rapidly increasing patient tional cancer scientists and by setting up an active genome and transcriptome level. To facilitate effi- numbers. We need help from clever automation,

1995 1996 1997 1999 2000 2001 2003 2004 2006 2010 First docetaxel therapy First use of stereotactic Psychosocial unit Palliative unit was HUS was founded First photo-pheresis First image-guided First use of First quality First use of VMAT for breast cancer in the radiotherapy was launched launched 1.1.2000. World’s first radiotherapy angiogenesis accreditation of stem (volumetric Nordic Countries imatinib treatment for inhibitor therapy cell transplantations in modulated arc GIST, and first IMRT the Nordic Countries therapy) treatment in the Nordic Countries.

6 7 MAJOR EVENTS 2018

Three new CAR-T-Cell devices Therapy

Comprehensive Cancer Centre acquired HUS’s Comprehensive Cancer Centre in- three new radiation therapy devices with troduced for research-use a complete- new spacious radiation therapy facili- ly new form of therapy that can even ties. The new radiation therapy devic- cure patients with recurrent cancer that es are used to carry out so-called stere- has proved resistant to common thera- otactic radiation therapy, which is used pies. The treatment is a precision immu- for tumors that require precision, such as notherapy where the patient’s own de- small brain tumors and other small tu- fensive cells (T cells in white blood cells) mors of the body. These radiation thera- are modified through gene technology to py devices are part of the largest acqui- identify and destroy cancer cells. This is sition of radiotherapy equipment in the called CAR T-cell therapy. The therapy history of HUS.came available through became available through clinical trials, clinical trials, and the first patient group and the first patient group to be treated to be treated is lymphoma patients who is lymphoma patients who have no other have no other effective therapies avail- effective therapies available. able.

2011 2012 2013 2014 2015 2016 2017 2018 2019 First use of MRI simulation Adjuvant imatinib Information on First cancer center Mobile application Early Phase Trial Unit Lutetium PSMA First use of CART BNCT device was and first use of breathing study lead by Prof. patients’ access to accreditation in the Noona was launched was launched therapies began therapy put into operation controlled radiotherapy Joensuu transformed care and open trials Nordic Countries First use of Geriatric-oncologic unit was the treatment protocol available online Rehabilitation unit for brachytherapy of launched. worldwide cancer patients was liver in the Nordic launched Countries

8 9 MAJOR EVENTS 2018

The first national cancer investiga- tor training course BNCT The first national training course for cancer investigators was organized at HUS in 2018. The training qualified par- HUS and US-based Neutron Therapeu- ticipants to act as investigators in clinical tics entered into a contract in 2016 to drug trials. As part of the course, partic- bring the first ever in-hospital BNCT de- ipants also took the Good Clinical Prac- vice to Helsinki. BNCT, which stands for National tice test. boron neutron capture therapy, is biolog- Laying the ically targeted radiation therapy. At the coordination center beginning of therapy, the patient receives foundation stone intravenous boron, which accumulates in for allogeneic stem New departments the tumor with the help of a delivery ve- of Bridge Hospital hicle. By radiating the boron-enhanced cell transplantation The radiation therapy department from cancer cells with a neutron shower, a Päijät-Häme was incorporated into Com- fission reaction occurs releasing large The foundation stone of Bridge Hospi- A national coordination center for allo- prehensive Cancer Centre in early 2018. amounts of energy, which destroys the tal was laid in Helsinki on 26 Septem- geneic stem cell transplantation began Päijät-Häme’s two linear accelerators cancer cells. The first target group for the ber 2018 starting the largest construc- its operation at the hematology depart- carry out external radiation therapy. Ra- therapy are patients with recurrent head tion project in the history of HUS. The ment of Comprehensive Cancer Centre. diation therapy planning can utilize a CT or neck cancer. However, the therapy can Bridge Hospital, which is to be built on Referrals from all over Finland are di- scanner, and controlled breathing tech- be used to treat other tumors as well pro- the Meilahti Hospital campus, will re- rected to the coordination center, where niques can be used when implementing vided that enough boron collects in the place Töölö Hospital and a part of the patients are designated weekly to one of therapy. Both Porvoo and Raseborg Hos- tumor and the tumor’s location is suit- Department of Oncology. The construc- the two centers in Finland that offer allo- pital breast surgery departments were ed for BNCT therapy. Building the device tion started with demolition and creating geneic stem cell transplantation, HUS or centralized to the Comprehensive Can- itself started at HUS in the summer of substitute premises in early 2018, and Turku University Hospital. cer Center’s Breast Surgery Department 2018, and the first trial therapies will be the hospital will open in 2023. starting from 2018. launched in late 2019 or early 2020.

10 11 Radiation Therapy and Radioisotope Therapies, BNCT

HUSin Solid Tumors Syöpäkeskus on vahvasti sitoutunut Hematology and syöpähoitojen Coagulation Disorders parantamiseen tukemalla Trial Unit syöpätutkimusta eri tavoin. Breast Surgery TREATMENT Palliative Care Center Rehabilitation

Medical Imaging

Pediatric Cancers

Nursing

Comprehensive Cancer Center in 2018 TREATMENT

RADIATION THERAPY

The Comprehensive Cancer Centre’s ra- tion of proton therapies, which require The radiation diation therapy division carries out ex- patients to be referred abroad. The lin- therapy division ternal radiation therapy within the Hos- ear acceleration-based boron neutron pital District of Helsinki and Uusimaa capture therapy (BNCT) device, which is is clearly the and Päijät-Häme Hospital District at the globally the first of its kind to be locat- largest and radiation therapy units at Meilahti Hos- ed in a hospital environment, will be tak- pital and at Päijät-Häme Central Hospi- en into use in 2019 and the first research most versatile tal. Internal radiation therapy (brachy- treatments will begin in early 2020 at therapy) and radionuclide (i.e. isotope) the latest. radiation therapies are also carried out in Hel- therapy ward in sinki. The radiation therapy division is Radiation therapy wards in Hel- clearly the largest and most versatile ra- sinki and Lahti Finland. diation therapy ward in Finland. It is External radiation therapy is provided the only one in Finland to provide liv- at the Department of Oncology (10 line- er brachytherapy, eye brachytherapy in ar accelerators in 2018, approx. 79,000 collaboration with the Eye and Ear Hos- treatments) and at the radiation therapy pital, and Lu177-octreotate treatments unit at the Päijät-Häme Central Hospi- for NET tumors. HUS Helsinki Univer- tal (2 linear accelerators, approx. 11,000 sity Hospital carries out all available ra- treatments). Radiation therapy is pri- diation therapy treatments centralized marily planned based on slice imag- to university , with the excep- es taken using HUS Helsinki Universi-

Number of radiotherapy patients at Department

of Oncology ty Hospital’s computer tomography and demand while utilizing the latest tech- volving radiation therapy typically last- magnetic resonance imaging simula- nology. ing around 1 – 4 days. Around 90 proce- +6%/year tors. Approximately 6,000 treatment cy- dures were carried out in 2018. 6000 2014–2018 cles are administered per year; 5,300 in Internal radiation therapy Helsinki and 700 in Lahti. The majori- Internal radiation therapy is provided at Radionuclide therapies (Isotope 5000 ty of these (>90%) take place on an out- the Department of Oncology in Helsinki therapies) patient basis. In 2018, radiation thera- and radiation therapy for eyes is provid- In Finland, the Comprehensive Can- py at the center increased by more than ed in collaboration with the Eye and Ear cer Center’s isotope therapy unit pro- 4000 15%, around half of which came from the Hospital. The most common treatment vides a uniquely extensive range of can- Päijät-Häme unit (added to HUS at the targets for high dose rate technology are cer isotope therapies. In addition to tra- 3000 beginning of 2018) and the other half is the prostate gland, and gynecological ditional thyroid radioiodine therapies, represented by an increase in radiation cancers. Liver brachytherapy treatment Ra-223-Xofigo therapy for skeletal me- 2000 therapy in Helsinki. became available in 2017. Around 500 tastases, LU-177-octreotate for NET tu- In 2018, three new radiation ther- treatments were administered in 2018. mors, Lu-177-PSMA for metastatic pros-

1000 apy facilities were taken into use. The In high dose rate treatments, treatment tate cancer, and Y90-SITT therapy for technology in the new radiation thera- is given using an lr-192 afterloading de- the treatment of hepatic lesions are al- 5169 4751 5261 4815 3968 3105 3061 3625 4095 4260 3590 4337 3642 3554 3550 3486 3880 py equipment is faster and more precise. vice and one treatment takes around ten so available and provided in collabora- 0 It can handle around half as many pa- minutes. In Finland, intraocular radi- tion with the HUS Medical Imaging radi- 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 tients more per day, so the equipment is ation therapy is centralized to Helsin- ology team. Around 500 treatments were Average change +3%/year in 2002-2010 and +4.5% in 2010-2014 capable of responding to the increase in ki and is a low-dose-rate treatment in- administered in 2018. The unit has two

14 15 TREATMENT RADIATION THERAPY

The most common procedures carried Treated/ out at the Radiation therapy division: imaged patients Number of treatments

External radiation therapy, Helsinki 5261 79081 External radiation therapy, Lahti 730 10864 Dose planning using computerized tomo- graphy 5230 - Dose planning using magnetic resonance imaging 1750 - Internal radiation therapy - 622 Radionuclide treatments - 443

The incidence SPECT-CT gamma cameras and a radi- compatible radiation therapy informa- onuclide laboratory for planning treat- tion systems. of cancer is ments. The majority of isotope therapy In 2016, HUS Helsinki University is given to patients in radiation isolation Hospital and Neutron Therapeutics en- increasing during treatment on ward 8 of the De- tered into a cooperation agreement to and, as a result, partment of Oncology. Some treatments build the world’s first boron neutron cap- can however be given on an outpatient ture therapy (BNCT) device to be locat- the number of basis, and this is expected to increase. ed in a hospital and will be used to be- referrals has The radionuclide treatment unit also car- gin patient treatment and scientific pro- ries out isotope studies relating to cancer jects. During 2018, the radiation thera- also steadily treatment. py division participated in the design of the construction project and the major- increased. Activities ity of equipment procurement that fell The incidence of cancer is increasing under the hospital’s responsibility was and, as a result, the number of referrals carried out. The BNCT project has pro- has also steadily increased. Compared gressed slightly behind schedule and the to 2017, the number of patients receiv- facilities will be released to HUS Helsin- ing external radiation therapy in 2018 ki University Hospital in April 2019. Af- increased by 5.1% in Helsinki and by as ter this time, testing will continue and much as 16% in Lahti. the first patients are expected to be treat- The radiation therapy unit at Päi- ed as part of a research protocol in 2019. jät-Häme and its personnel transferred Renovation work on the old Depart- to activities at the Comprehensive Can- ment of Oncology will continue and part cer Centre’s radiation therapy division of the Radiation Therapy Ward’s office in early 2018 and radiation therapy spe- and appointment facilities will have to be cialists began work there. As part of moved out of the way to the third floor of treatment staging, patients in the Päi- the clinic building. jät-Häme hospital district are directed to specialist radiation therapy in Helsinki. In the specific catchment area, an oncol- ogist shortage in Lappeenranta and Kot- ka has been corrected so that oncolo- gist work has been reduced by one day per week from early 2019 and this work can be carried out remotely as a result of

16 TREATMENT

Major tumor groups All appointments First visits SOLID TUMOR DIVISION Breast cancer 18 183 844 Bowel and rectal cancer 6 015 473 Lymphomas 5 876 230 Prostate cancer 3 912 110 The Comprehensive Cancer Centre’s sol- ly in the Comprehensive Cancer Centre’s duction of treatment outside of research Lung cancer 2 876 81 id tumor division is responsible for pro- educational meetings. have begun at the Comprehensive Cancer viding outpatient medication to adult The Comprehensive Cancer Centre Centre. cancer patients, ward care and, for some has again been able to respond to a rise In spring 2018, the Day Hospital car- is planned for patients and implement- Wards respond to the increasing number of pa- cancers, follow-up care after prima- in the number of referrals in 2018 and ried out a Lean development project re- ed to a high-quality by a multi-profes- Approximately 3000 patients are treat- tients by e.g. making the division of work ry treatment. There is a consulting phy- the center treated 8.1% more patients lating to the urgent treatment of patients sional care team specializing in the rele- ed on the Comprehensive Cancer Cen- between personnel groups more effec- sician at the solid tumor division who than in the previous year. In 2018, the with metastatic bowel cancer. In the fall, vant cancer. tre’s two wards each year. A total of eight tive, and utilizing digitalization by using provides oncological consultations for median treatment periods for the larg- a Lean development project was carried For cancer patients, the deployment doctors, 50 nurses and three secretar- Noona applications customized for can- external colleagues over the phone dur- est disease groups remained good and out on ward 8 to provide smoother ac- of the digital Noona applications has ies work at the Comprehensive Cancer cer patients, for example. The center will ing office hours. Outside office hours, close to the national recommendations, cess to treatment and activities for emer- been extended to the Day Hospital. It Centre. Both wards provide long chem- strive to increase the number of digital questions are answered by the on-call although the number of personnel at the gency patients. Both Lean projects were is used at appointments and to monitor otherapy treatments requiring over- remote consultations and appointments. physician. center has increased at a significantly very successful and the smoothness and adverse treatment effects. In late 2018, night stays. In addition, the wards focus This is estimated to result in treatments Activities have increased during slower rate than the number of patients. efficacy of activities were increased. some of the doctors’ appointments were on treating patients with severe cancer that are better targeted to those who will 2018, and this is reflected in a rise in the The majority of systemic treatment In 2018, ward 7 was named one of replaced with a digital letter appoint- symptoms or problematic adverse effects benefit from them and a reduction in number of new referrals as well as in a is provided at outpatient clinics and the HUS Helsinki University Hospital’s best ment if the patient reported that their caused by anticancer drugs. Ward 7 pri- treatment complications. The division of rise in the number of visits and system- number of chemotherapy doses has in- units for excellence in wellbeing at work. condition had remained good during a marily deals with chemotherapy treat- work between doctors and nursing per- ic treatment provided. Activities have al- creased by 8.9% in one year. new type of drug treatment. ments for lymphomas and testicular can- sonnel is being piloted in accordance so been made more diverse. Since early The Comprehensive Cancer Centre Day Hospital The geriatric oncology outpatient cers. Autologous stem cell transplanta- with the ”back office” model on ward 4 2018, the solid tumors division has sold has introduced new anticancer drugs in Activities at the Comprehensive Cancer clinic serves patients over the age of 80 tion activity has also risen, and in 2018, of the Bridge Hospital’s Day Hospital, oncological services to oncology outpa- accordance with HUS Helsinki Univer- Centre’s Day Hospital include appoint- as part of its appointment activities. The 31 autologous stem cell transplantations which treats breast cancer patients. In tient clinics in Päijät-Häme, where drug sity Hospital guidance based on assess- ments with doctors, specially trained increase in elderly patients is addressed was carried out there. Ward 8 primarily the future, we will seek to make it pos- treatments and follow-ups are provid- ments by the HUS Clinical Group, Fimea nurses and specialist employees, as well by transferring the geriatric oncology deals with isotope treatments such as ra- sible for an increasing number of spe- ed to cancer patients. Meetings are held or Palko. Finland’s first CAR T-cell ther- as anticancer systemic treatment ad- outpatient clinic’s activities to the Day dioiodine and lutetium treatments. The cialists to undertake one or two days per regularly with the leadership of all spe- apies for lymphoma patients were con- ministered at the Day Hospital. Approx- Hospital, where elderly patients are pro- number of lutetium therapies is clearly week of part-time work at the Clinical cific catchment areas, twice per year. ducted at the Comprehensive Cancer imately 40 doctors and 90 nurses work vided with treatment advice and any on- on the rise, and in 2018, approximately Trial Unit in order to diversify their jobs. Personnel from hospitals in specific Centre within the framework of scientific at the unit, which provides a total of 96 cological treatments are planned by on- 380 radioisotope therapies were carried We can also contribute to the conditions catchment areas can participate remote- research and preparations for the intro- beds. Individualized systemic treatment cologists specializing in geriatric care. out on ward 8. necessary to increase scientific work at There is also an outpatient clinic at the center by creating joint posts. the Day Hospital that provides long-term Outlook for the future follow-up for young adults who suffered The Comprehensive Cancer Centre’s ac- from cancer as children. In addition to tivities will remain busy as the total other psychosocial support, occupation- number of cancer patients continues to al therapy services are now also available grow as a result of an ageing population to young patients receiving treatment. and new treatment options. The aim is to

Noona users

Appointments

Systemic treatment

0 200 400 600 800 1000 1200

2018 2017

18 19 TREATMENT

Indications for allogeneic stem cell HEMATOLOGY DIVISION transplantation in 2018

AML (34) The largest The clinic is the largest hematology unit cell transplantation units, and on the he- MDS (14) in Finland and plays a key national role matology wards (7A and B). MM (7) hematology unit in e.g. stem cell transplantations, the ALL (6) treatment of rare, hereditary blood dis- Appointment-only outpatient MF (5) in Finland eases, early-phase drug development and clinics, day hospital operations AA (4) translational research. Operations are and the hematology wards NHL (4) supported by the Finnish Hematology Appointment-only outpatient clinics op- PNH (1) Register and the first biobank in Finland erate at Meilahti Triangle Hospital and Mycosis fungoides (1) to focus on a single group of diseases Peijas Hospital, providing university KML (1) (FHRB). The research carried out by the hospital-level diagnostics and outpatient T-PLL (1) hematology department focuses on mo- treatments. A large number of treat- Cartilage-hair hypoplasia (1) lecularly targeted pharmacotherapy, the ments for blood diseases can be adminis- genetics of hematology, immunotherapy, tered at home or at the day hospital. The and coagulation disorders. Patients are Meilahti Triangle Hospital has two he- treated at the outpatient clinics for he- matology wards, one of which is for pa- matology and rare hematological diseas- tients who are acutely ill with blood dis- and allogeneic stem cell transplanta- of hemophilia and offers a wide range of Activities es, at the coagulation disorder and stem eases, while the other is for autologous tions. There are a total of 32 beds on multi-disciplinary care for patients with The incidence of blood diseases is in- the wards. Hematology patients are also hemorrhagic diseases. It also provides creasing and as a result, the number of treated on the ward at consultation services for other medical referrals has also steadily increased. Peijas Hospital (7 beds). specializations. Compared to 2017, the number of refer- rals increased by 20% (2,169 referrals in Outpatient clinic for rare blood Stem cell transplantation unit 2018) and the number of patients treat- diseases The stem cell transplantation unit at ed rose by 11% (4,976 patients in 2018), A family-centered joint outpatient clinic HUS is the largest in Finland and the (Figure 2). 1,195 new patients were treat- for rare hematological diseases in adults coordination of all allogeneic stem cell ed in 2018, which was 3% higher than in and children was established in 2018. It transplantations is nationally central- the previous year. The number of outpa- provides centralized treatment for hemo- ized to the unit. In 2018, 79 allogeneic tient contacts rose by 17% compared to globin abnormalities, hereditary cell de- stem cell transplantations and 41 autolo- the previous year. An increasing num- ficiencies and syndromes that cause a gous stem cell transplantations were car- ber of contacts were treated as remote predisposition to blood cancers. The out- ried out. The majority of allogeneic stem contacts. The total number of appoint- patient clinic provides a consultation cell transplantations are donated by reg- ments with doctors increased by 3% on service and specialist treatment for ap- istered HLA-compatible donors. Haploi- the previous year, and the number of re- proximately 250 patients each year. Ser- dentical transplantations from first-de- mote contacts was 17%. Blood diseases vices are also provided to patients out- gree relatives make up a growing group. are largely diagnosed at specialist medi- side HUS. The outpatient clinic received The majority of patients treated with al- cal and university-level treatment units, official status as a rare disease center in logeneic stem cell transplantation suffer such as the hematology clinic. Patients 2018. from acute myeloid leukemia (Figure 1) are usually referred quickly for diagnos- and multiple myeloma, treated with au- tic tests: within 1-21 days depending on HUS Coagulation Disorder Unit tologous transplantation. the suspected blood disease. For some The Coagulation Disorder Unit at HUS In addition to autologous and allo- patients, treatment begins as soon as is the only unit in Finland that focuses geneic transplants, the first CAR T-cell their diagnosis is confirmed, while oth- on the treatment of patients with hem- therapy at HUS was given to oncological ers are treated later on, depending on the orrhagic and occlusion disorders. It pro- research patients at the stem cell trans- nature of the blood disease. vides nationally centralized treatment plantation unit. There were 11,762 treatment days in for some of the most challenging cases 2018. 12% of these took place on the in-

20 21 Number of hematology patients treated at HUS Helsinki University Hospital

5000

4000 +11 % 2017–2018 3000

2000

1000 4147 4976 4109 4481

0 2015 2016 2017 2018

ternal medicine ward at Peijas Hospi- plantations (obtained from healthy stem HUS area patients suffering from acute tal, while the rest occurred on two differ- cell donors), the treatment of acute leu- leukemias is centralized to the Meilah- ent wards at the Meilahti Triangle Hos- kemias, and the treatment of other blood ti Hospital, which is why these patient pital. Ward treatment days rose by 4% cancers. 74 allogeneic stem cell trans- groups make up some of the largest pa- compared to the previous year. In recent plantations were carried out in 2014, 94 tient groups in Meilahti’s outpatient clin- years, efforts have been made to shorten were carried out in 2015, 79 were carried ics and on its wards. The most common the on-ward treatment period for hema- out in 2016, 71 were carried out in 2017, chronic hematological diseases, such as tology patients and to enable home care. and 79 were carried out in 2018. 73% of myeloma, chronic lymphocytic leukemia The average treatment time on the stem the transplants were taken from regis- and myeloproliferative diseases are high- cell transplantation ward was 19 days, tered donors, 18% were donated by sib- lighted at the Peijas outpatient clinic and while it was 8 days on a regular hema- lings, and 9% were haploidentical trans- on its wards, and at the Meilahti outpa- tology ward. The most significant prod- plantations. In accordance with treat- tient clinic. uct groups are allogeneic stem cell trans- ment staging, the active treatment of

The largest patient groups Patients treated Ward treatment days Outpatient clinic contacts

Myeloproliferative diseases 771 316 3444 Multiple myeloma 513 1521 7602 Coagulation disorders 487 59 931 Acute leukemias 307 5063 5779 Chronic lymphocytic leukemia 272 175 1781 Chronic myeloid leukemia 176 107 631 Myelodysplastic syndromes 154 882 2088

23 TREATMENT

CLINICAL TRIAL UNIT

(A) significant number of clinical drug Some of our main partners include the trials carried out at HUS Helsinki Uni- Clinical Research Institute HUCH, 17 versity Hospital are conducted at the HUSLAB, HUS , HUS Medical New clinical trials Comprehensive Cancer Centre’s Clini- Imaging Center, the University of Helsin- cal Trial Unit. Activities have been in- ki, Helsinki Biobank and the Institute for creasing since 2010. In 2018, 17 new in- Molecular Medicine Finland. ternationally competitive clinical drug trials were initiated at the unit, includ- ing Finland’s first CART study. In 2018, the unit was also the first in the world to The aim is to carry out first-in-human trials on three • provide opportunities for an drugs. A total of 97 clinical drug trials increasing number of patients were open, of which 72 related to oncolo- to be among the first to re- gy and 25 related to hematology. 39 clini- ceive new, safer and more ef- cal drug trials were active, 58 were in the fective trial treatments follow-up phase, and 16 were investiga- • ensure a high quality of clin- tor-initiated. 125 patients were recruited ical drug trial activities in all for trials. The unit administers around areas 100 clinical drug trial treatments each • be a competitive excellence month. unit by networking ever more The early-phase molecular trial unit closely with international (Phase I Center) operates as part of the clinical drug trial groups and Clinical Trial Unit. The establishment of basic research Number of new oncological trials the Phase I Center in 2016 has increased the number of early-phase clinical drug trials in the specializations of oncology 15 and hematology. The center is active in Contact persons the Nordic Early Clinical Trial (NECT) network (https://nordicnect.org). Oncology: 12 Personnel at the unit include a unit Sirpa Leppä, manager, 3 coordinators, 14 research Professor, Head Physician nurses, 2 infusion nurses, a secretary, 5 Katriina Peltola, 9 doctors and several part-time research Docent, Chief Physician doctors. In 2018, a full-time chief physi- Marita Repo,

cian in early-phase oncological trials and Nurse Manager 6 3 new research nurses began work at the Susanna Miettinen, unit. Research nurse responsible for In the fall of 2017, we organized a day-to-day activities 3 cancer research nurse course in the HUS Helsinki University Hospital Specif- Hematology: In 2018, 17 new ic Catchment Area which was complet- Kimmo Porkka, 0 internationally competitive ed by 22 research nurses. In the spring Professor, Head Physician 2013 2014 2015 2016 2017 2018 clinical drug trials were of 2018, we organized a national clini- Saara Vaalas, initiated at the unit, including cal cancer investigator course, which was Research Coordinator Finland’s first CART study. completed by 25 clinical researchers. Phase 1/2 Phase 2 Phase 3 Phase 4/other

24 25 TREATMENT

THE LARGEST BREAST SURGERY UNIT IN THE NORDIC COUNTRIES

The Breast Surgery Unit performs almost Unit at the start of 2018. In 2018, a to- Proven effective treatment 1,500 breast cancer operations each year. tal of 1,480 breast cancer patients under- • Approximately 1,500 breast can- It also performs surgery to rule out or di- went surgery. Of these, 1,427 were new cer operations each year agnose breast cancer. The Breast Surgery cases of breast cancer, while 53 cases in- • Excellent treatment outcomes Unit also treats and operates on benign volved the recurrence of breast cancer. and expertise tumors and in the breasts. Over 70% of the operations were breast- • 11 specialists in the surgical Women diagnosed with a gene muta- conserving. treatment of breast cancer, 3 tion that increases the risk of breast can- The Breast Surgery Unit’s treatment breast cancer nurses and 26 nurs- cer are also treated at the Breast Surgery outcomes have proven excellent. In a five- ing staff Unit. year follow-up period, the risk of breast • Internationally respected re- The Breast Surgery Unit carries out cancer recurrence in the breast or arm- search work high-quality scientific research to devel- pit area in operated patients is just 2–3%. op therapies, and the results have been The five-year survival rate was 98% in published widely in medical journals and patients with a tumor size of less than at international cancer conferences. 2cm. Approximately 90% of patients Surgery at Porvoo and Tammisaari treated are satisfied or very satisfied with was centralized to the Breast Surgery the treatment they have received.

26 TREATMENT

PALLIATIVE CARE

Better quality of life and tions, and family members’ coping abil- 1 in 3 symptom control ity and support needs are assessed at an The HUS Palliative Care Center is re- appointment. In addition, the center also Finns will get sponsible for palliative care, education assists in the provision of home help and and scientific research throughout the end-of-life care for those who need it. cancer entire hospital district. Palliative care seeks to alleviate patients’ physical, psy- chosocial and spiritual suffering, to im- A networked prove the quality of life for the patients consultation clinic and their loved ones, and to maintain pa- • Coordinates HUS Helsinki Uni- tients’ functional capacity. The center’s versity Hospital’s palliative care extensive competence and high-quali- and hospice care network in co- ty care, provided in some of the most dif- operation with the Cancer Society ficult circumstances, have their founda- of Finland’s hospice, with home tion in the professionalism of personnel hospitals, palliative care units and in cooperation with other units. The and hospices in primary health doctors at the center are palliative care care. specialists with backgrounds in various • A consulting outpatient clin- medical specializations. The care team ic that serves roughly 2,000 pa- also includes social workers, physiother- tients each year. A consulting apists, a clinical dietitian, psychiatrist, doctor and nurse also visit other psychologists, a psychotherapist and a clinics to provide consultation. chaplain. • A multi-professional and mul- Around 2,000 comprehensive care tidisciplinary center, the cent- SUPPORT WITH CHANGE plans for palliative or hospice care are er employs specialist physicians The Comprehensive Cancer drawn up with patients and their families from various medical specializa- Centre treats approximate- each year. The need for symptom relief tions with special competence in Cancer drastically changes a person’s day-to-day for young adults suffering with cancer. The occupa- ly 30,000 patients each year and psychosocial support, the support palliative medicine. life, including how they cope at home, their ability tional therapist primarily works with young people and one in ten require spe- measures required by patients in home to work, finances and relationships. At the Compre- aged between 18 and 35. The service aims to retain cial psychosocial support. care, the patient’s wishes and expecta- hensive Cancer Centre, patients and their relatives the best possible level of functional capacity, as well have the opportunity to talk with expert profession- as to strengthen the young person’s independence als and receive guidance and advice. in everyday life and to participate in making their Finland’s only psychiatrist-led psychosocial sup- own life choices. port unit operates at the Comprehensive Cancer Centre and has been at HUS Helsinki University Hospital for more than 20 years. The unit’s task is to talk with patients who require special support to help them cope with the new and difficult circum- stances arising from cancer. Patients and their rela- A unique psychosocial unit tives can discuss their situation with a social work- • Approximately 600 patients per er, who provides personalized advice and guidance year on many of the problems and questions that can • 3-4 visits per patient on average arise from the change in situation. A hospital chap- • At least one in ten cancer patients lain visits the clinic regularly and is available to require special psychosocial sup- meet with patients and their families if they wish. port Since 2017, the Comprehensive Cancer Cen- tre has operated an occupational therapy service

28 29 TREATMENT REHABILITATION AND MEDICAL IMAGING

MEDICAL IMAGING AS THE BACKBONE OF TREATMENT

HUS Medical Imaging Center is the largest pro- vider of medical imaging examinations in Fin- land. It is responsible for the diagnostic exami- Patients are examined using nations of patients at the Comprehensive Cancer • ultrasound (e.g. of the breasts and stomach ar- Centre. ea, contrast-medium examinations of the liver, The Comprehensive Cancer Centre’s radiogra- ultrasound-guided sampling) phy unit employs seven radiologists and 12 radi- • computed tomography ographers. The radiologists work closely with the • magnetic resonance imaging physicians who are treating the patients. Patient • mammography (breast cancer screening) cases are reviewed by various specialists at daily • PET-CT scan meetings. Patients at the Comprehensive Cancer Centre are also examined at other HUS Medical Imaging Cent- er units in the Meilahti campus area.

PHYSIOTHERAPY AND NUTRITIONAL CARE HELP TO IMPROVE PATIENTS’ PHYSICAL CONDITION

Appropriate nutrition and maintaining the pa- and advice on how to purchase and use the devices. tient’s mobility and functional capacity are impor- Dietitians assess the patient’s level of nutrition and tant factors during cancer treatments. The physi- draw up nutrition plans if necessary. otherapists and clinical dietitians working at the HUS Comprehensive Cancer Centre guide and counsel patients in order to achieve the best possi- ble treatment outcomes. Rehabilitation Physiotherapy promotes the patient’s mobili- • promotes patients’ mobility and functional capacity ty and functional capacity using therapeutic exer- • provides preconditions for successful treatment cise and manual therapy. The physiotherapist al- • evaluates the patient’s needs for medical devices so individually evaluates the need for medical de- and provides advice on how to use them vices, such as supportive sleeves after breast cancer • promotes recovery after cancer treatments surgery, mobility aids, and other devices that sup- port day-to-day activities, and provides guidance

30 31 TREATMENT PEDIATRIC CANCERS CUTTING-EDGE CANCER CARE FOR PEDIATRIC PATIENTS

One in three Finnish children with can- dren are cured. The excellent results are New Children’s Hospital cer is treated at HUS, at New Children due to goal-oriented research and close, offers pediatric cancer Hospital’s wards concentrating on on- international co-operation in treatment treatment on one campus: cology, hematology and stem cells. We protocols. • Dedicated and research-oriented always aim to offer patient-driven and Brain tumors are the second most pediatric cancer center with family-friendly care. The hospital is in- common pediatric cancer, and lympho- excellent clinical results. volved in several Nordic and European mas are in third place. In Finland, the • Treats the most common treatment protocols. prognosis for cure in brain tumors is pediatric malign diseases, The survival prognosis for pediatric 75.6%, and 91.2% in lymphomas. Both including leukemia and cancer patients in Finland is among the are at a high level in international com- lymphoma, with excellent results best in Europe: over 80% of children are parison. typical of top-level international cured. The prognosis for leukemia, the centers. most common malignant disease in chil- • Accredited national unit for dren, has improved enormously during Over 85% are cured pediatric allogeneic organ the past decades. The survival prognosis for transplants. HUS’s results in the treatment of pediatric cancer patients in most common pediatric cancer, ALL, are Finland is among the best in among the best in the world: 97% of chil- Europe.

32 TREATMENT

NURSING 4,8 INDICATOR RESULTS 2018 Average grade CHART 1 Nursing at the Comprehensive Cancer matology and day wards, teamwork on framework of the Magnet Hospital mod- prevalence on wards on the 3rd Thursday of in feedback each month, number of ≥ stage-2 pressure ulcers /1000 treat- Centre is carried out in accordance with the radiation therapy ward, and an in- el since 2014. The production of care in- ment days (key target incidence < 1.9%): HUS’s strategy, which focuses on good dependent nurse practice at the oncolo- dicators and the comparison of results in statements on a leadership, well-functioning structures, gy outpatient clinic and Palliative Care an international database has continued scale of 1 to 5 Q1/2018 2 pressure ulcers originating elsewhere high-quality professional practice and Center. As a resource, care is allocated in 2018. In the comparison, we monitor Q2/2018 5 pressure ulcers originating elsewhere the utilization of new knowledge in pa- appropriately using patient classification the incidence of ≥ stage-2 pressure ul- Q3/2018 no pressure ulcers tient care as outlined in the Magnet Hos- and a daily resource allocation model. cers and patient injuries due to falls per Q4/2018 4 pressure ulcers originating elsewhere pital model. Nurses participate develop- Patient-centered care is supported by 1,000 treatment days, as well as the inci- total 0 ment through expert groups operating means of a patient advisory board (from dence of cannula and catheter-associat- at different levels within the organiza- 2016) and experts by experience (from ed infections per 1,000 cannula or cath- tion. Multidisciplinary care work is car- 2018). The activities are coordinated by eter days. The systematic screening of CHART 2 ried out in a variety of operating envi- persons with a background in nursing. cancer patients for the risk of malnutri- Number of falls that have caused patient injury, at a depart- mental level (key target number <0.8 / 1000 treatment days): ronments: on oncology, hematology and Feedback on patients’ satisfaction with tion has continued. Patient feedback on breast surgery wards, and in an outpa- care is collected continuously. The intro- care work is collected quarterly. Nurses’ Q1/2018 20 on wards tient environment, such as at the oncol- duction of health technology has provid- engagement with their work is assessed Q2/2018 28 on wards ogy outpatient clinic, the breast surgery ed new methods for care, e.g. the use of twice per year using the Nurse Engage- Q3/2018 12 on wards and 1 at an outpatient clinic outpatient clinic, the radiation therapy mobile applications in remote monitor- ment Survey (NES). Q4/2018 20 on wards and 1 at an outpatient clinic ward, the day ward, and at the Palliative ing, and the use of medication guidance total 82 Care Center. videos to provide patient guidance. Number of falls on wards 3.6 / 1000 treatment days Models for carrying out nursing in- Nursing at the Comprehensive Can- clude a primary nursing system on he- cer Centre has been developed within the CHART 3 Central venous cannula-associated sepsis on wards:

Q1/2018 7 Q2/2018 9 Degree of engagement in 2015 and 2018, all respondents Q3/2018 3 Q4/2018 5 50 total 24

Engagement was measured PATIENT FEEDBACK ON CARE 2018 TAULUKKO 4 using the following statements: (N = 1205) Urinary catheter-associated infections on wards: 40 1. I would recommend this or- ganization to my friends as an Patient feedback on care consists Q1/2018 0 excellent workplace of 23 questions. The feedback 2. My organization inspires me has been extremely good. On a Q2/2018 2 to perform with excellence 30 Q3/2018 1 3. I will most likely be working scale of 0-5, statements scored an Q4/2018 0 in this organization in three average of 4.8 (range 4.66-4.97) at a years’ time departmental level. total 3 4. I am ready to invest in and 20 work hard for the success of my organization FUTURE TARGETS TAULUKKO 5 The aim is to achieve higher than Malnutrition risk screening (key target ≥ 80%) average Magnet Hospital Model Hematology wards 7A and 7B 91 % 10 indicator scores in national and international comparisons. Another Oncology wards 7 and 8 95 % indicator target is to achieve the Breast surgery ward 47 % 8,8 19,3 13,7 18,6 25,5 23,5 48,4 42,2 targets set out for key objectives in Outpatient clinics and day wards 22 % % 0 Radiotherapy ward 2 % Engaged Satisfied Uncertain Not engaged HUS’s strategy.

2018 (n=217) 2015 (n=102)

34 35 COMPREHENSIVE CANCER CENTER IN 2018 Operating expenses and depreciations in 2018 (1000 €) 138.7 €M

Other expenses (9.3 €M) 7% Population in HUS Population in Other purchased services (17.5 €M) 13% district HUS’s Specific Personnel costs (29.6 €M) 21% Hospital services from other HUS units (14.5 €M) 10% Catchment Area Medical imaging (9.5 €M) 7% 1 654 333 (includes HUS) Laboratory (10.6 €M) 8% Other substances and equipment (5.6 €M) 4% 2 164 311 (42.1 €M) 30%

Number of Number of new Number of beds Number of patients treated patients treated outpatient chairs at the HUS CCC at the HUS CCC 95 96 30 144 11 5 07

Inpatient Outpatient Number of Number of periods service products chemotherapy radiotherapy 249 706 treatments fractions 5 534 63 500 90 000

Referrals 14 133

36 37

Quality and Patient Safety

Patient Involvement

HUSin Patient Services Syöpäkeskus on vahvasti sitoutunut syöpähoitojen parantamiseen tukemalla syöpätutkimusta QUALITY eri tavoin. AND PATIENT INVOLVEMENT QUALITY AND PATIENT INVOLVEMENT

QUALITY AND PATIENT SAFETY

The principal goal of the Comprehensive ty coordinator pairs. The Comprehen- Cancer Centre is to guarantee patients sive Cancer Centre has a guideline for high quality and effective treatment with- handling adverse events. Serious ad- out delay. Operations are founded on na- verse events are discussed at the serious tional legislation, on the strategy of HUS adverse event debriefing chaired by the and of the Comprehensive Cancer Cen- Quality Manager, using root cause anal- tre, on the objectives defined for the op- ysis. Measures to be taken are agreed on, erations and on systematic monitoring, an implementation plan is drawn up, a evaluation and development. The guide- coordinator is appointed and execution of line for operations is the Quality and Pa- the measures is monitored. tient Safety Plan adopted by the HUS Ex- The Comprehensive Cancer Cen- ecutive Board on 15 April 2019. tre has a patient safety working group Establishing culture of quality and that meets four times a year. The work- patient safety is important and requires ing group discusses all adverse events the assuming of shared responsibility that are in risk categories III to V or have and an active and multidisciplinary ap- caused moderate or serious harm, moni- proach on various levels of the organi- tors the execution and effectiveness of the zation. Various quality control systems resulting development measures and sub- (OECI, JACIE, JCI, Magnetic Hospi- mits development proposals to the quali- tal, etc.) and tools (lean, etc.), and inter- ty and patient safety steering group of the nal and external audits, are used for eval- HUS Joint Authority Administration for uating and further developing our oper- discussion. ations, along with adverse event reports The units of the Centre have desig- (Haipro), patient feedback, patient com- nated quality and patient safety coordi- plaints and patient objections. Success- nators responsible for the development, fully establishing a culture of patient evaluation and monitoring of quality and Centre participated in the Kaizen week project was that patients were treated in goals, quality and safety and serve as an safety requires the entire personnel to patient safety in their respective units. for applying to Lean activities at HUS. four treatment rooms instead of six as be- aid for improving operations. The man- take part actively in the evaluation and Units prepare an interim annual report The aim for inpatient ward 8 was that fore, appointment times were distributed agement of the Comprehensive Cancer development of our operations. on adverse event reports three times a emergency patients would be admitted more evenly and the time taken by nurs- Center participates in Daily Management year. to the ward within four hours of arrival. es for registration was reduced by 30% to meetings regularly. Adverse events 2018 The project involved creating an electron- 50%. A new functionary, the Clinic Senior In 2018, just over 1,000 adverse event re- Lean and Kaizen as develop- ic ward waiting list for emergency pa- Pharmacist, began work at the Compre- ports were recorded (HaiPro), of which ment tools tients, staggering arrival times for elec- Daily Management board as an hensive Cancer Centre at the beginning 9 were serious adverse events. The larg- In 2018, three Comprehensive Cancer tive patients, preparing further treatment operations management tool of 2018. The job involves promoting a cul- est number of adverse events was report- Center employees underwent Lean train- plans for patients on the day prior to dis- The purpose of Daily Management is to ture and process of drug safety; distribut- ed for drug and fluid therapy (34%), fol- ing involving development actions in charge, and discharging patients between steer and improve operations and to en- ing drug information; training, advising lowed by communications and informa- their units. The topic was the monitoring 09.00 and 10.00. Over a six month mon- sure that every employee is familiar with and inducting personnel; monitoring and tion management (32%). Some 37% of the of melanoma patients using a mobile app, itoring period, 90% of emergency pa- the goals for the day and their duties and analyzing drug therapy deviations and ad- adverse events were hazards that were ei- improving first appointments for radio- tients were admitted to the ward in less that any potential problems are identi- verse effects; and identifying drug therapy ther anticipated or corrected before any therapy patients, and streamlining first than four hours. The aim for day ward 5 fied. One of the major goals of Daily Man- risks. The Clinic Senior Pharmacist is al- Establishing culture of quality actual damage could occur. Of the ad- pre-op visits to the clinic was to improve access to treatment for agement is to solve within the unit as so required to conduct medication safety and patient safety is important verse events affecting patients (n=632), for breast cancer patients. patients with metastasized bowel can- many issues as possible. The units of the checks on wards or on individual patients and requires the assuming of 3% (n=30) caused moderate harm to a In all, seven Comprehensive Cancer cer. In the course of the project, staff du- Comprehensive Cancer Center each have if medication problems are suspected. shared responsibility and an patient, and 0.4% (n=4) caused serious Centre employees have undergone Lean ties were clarified, duplication was re- a Daily Management board on the wall. With the appointment of the Clinic Senior active and multidisciplinary harm to a patient. training. duced and the duties, booking templates Each unit has determined and select- Pharmacist, the safety and quality of drug approach on various levels of Adverse event reports (HaiPro) are In 2018, inpatient ward 8 and day and room arrangements for drug thera- ed indicators reflecting their respective therapy particularly for patients receiving the organization. processed by quality and patient safe- ward 5 of the Comprehensive Cancer py were changed. The result of the Kaizen characteristics so that they measure their oncological drugs orally have improved.

40 41 QUALITY AND PATIENT INVOLVEMENT QUALITY AND PATIENT SAFETY

Comprehensive Cancer Centre focus areas The Helsinki with the Magnet Hospital Model was con- that are used for planning and further de- tinued in 2018, including preparation for velopment of operations. The informa- and how they were addressed in 2018 University the Joint Commission International (JCI) tion gained from patient feedback is used Hospital Cancer evaluation. for instance in reporting according to the The purpose of the OECI network is to adopted patient safety plan. improve and harmonize oncological treat- Objections are processed as specified in Focus area Measures Outcomes Centre received ments, to share good practices among the Chief Medical Officer’s guideline; the Promoting a culture of patient safety and • Involving personnel in the processing of • Adverse events reports have led the status of hospitals and to foster the integration of respondent at the Cancer Center is the increasing the number of improvement adverse event reports and in problem to 22 improvement measures scientific research into care processes. Administrative Chief Physician or the measures based on adverse event reports solving Comprehensive • Entering improvement measures in the In spring 2018, the HUS launched a Chief Physician of the Hematology Divi- HaiPro system Cancer Centre in Joint Commission International (JCI) ac- sion. creditation project, where the Compre- The Patient Ombudsman prepares a re- Piloting patient safety walks for managers • Cancer Centre participated in the pilot • Patient safety walks adopted as 2014 and supervisors project HUS practice hensive Cancer Centre is involved, en- port on customer feedback for each divi- • Patient safety walk conducted on four hancing its quality and patient safety ef- sion three times a year. Objections, com- wards forts in its sector. JCI originated in the plaints and patient injury reports are pro- USA and is now the most widespread hos- cessed at the relevant operating unit, ei- Correct and sufficient use of hand sanitizer • Hygiene coordinators in units to be boosted through training and monitor- • Hygiene coordinators in units trained to have begun to monitor hand pital accreditation system in the world. ther at a departmental meeting or in a ing of consumption monitor hand hygiene hygiene JCI is a comprehensive quality system, one-on-one discussion with a supervisor • Consumption targets per unit to be cal- • Consumption targets per unit covering all aspects of hospital operation: as part of the unit’s quality control pro- culated have been calculated, and units are monitoring consumption patient care, administration, personnel cess. If the feedback concerns operations Improving medication safety • Preparing a risk drug list for the Compre- • A risk drug list for the Cancer Cen- training and evaluation of qualifications or processes at the unit, the information • Developing the drug therapy process hensive Cancer Centre tre and a guideline concerning and competence. Facilities and their safe- received will be used for improving the • Identifying risk drugs at the Cancer • Drug therapy plan to be included in in- the adverse effects of oncolog- ty are also evaluated. operations of that unit. Centre duction training ical drug therapy for adult pa- • Ward drug therapy plans to be updat- tients have been prepared In 2018, the Comprehensive Cancer Cen- ed to be consistent with ward opera- • On wards, drug cabinets have Patient feedback, complaints tre received 19 patient injury reports, of tions been reorganized by therapy and objections group which two resulted in compensation be- • The Clinic Senior Pharmacist has Patient objections, injuries and com- ing paid. given briefings in units on the HUS plaints are important forms of feedback Pharmacy general guidelines • The Clinic Senior Pharmacist is ac- tively involved in the updating of units’ drug therapy plans

Quality assessment tional and scientific strategies were pre- cer Centre is also participating in the In 2014, the Comprehensive Cancer Cen- pared for the Comprehensive Cancer Cen- peer review of treatment paths for early- tre became the first university hospital in tre. In a pioneering project, monitoring phase breast cancer and prostate cancer the Nordic countries and the second one of patient treatment access times was be- in the OECI network. The Comprehen- in Europe to receive the highest status gun, and the data are published as a guar- sive Cancer Centre has continued to en- awarded by the Organisation of European antee of minimizing delays. Treatments gage in national peer review of operations Cancer Institutes (OECI): Comprehensive for each individual patient are decided at with other university hospitals. In a new Cancer Centre, or CCC. multi-professional care meetings that are departure, peer review among hospitals To achieve CCC status, a hospital must held frequently, and the tumor groups up- within our own specific catchment area have a high level of quality in treatment, date their disease-specific treatment rec- was launched. The Comprehensive Can- a patient-oriented care culture and cut- ommendations in real time. cer Centre has begun preparation of the ting edge scientific research and train- In 2018, the Comprehensive Cancer Cen- HAKE and ERN CAN applications for the ing. The accreditation process involved tre focused on preparing for the OECI Southern Finland Regional Cancer Cent- improving operations in a variety of ways CCC reaccreditation, which will be con- er in the context of the latter’s operations. so as to comply with the criteria. Opera- ducted in 2019. The Comprehensive Can- Development of care work in accordance

42 43 QUALITY AND PATIENT INVOLVEMENT

PATIENT INVOLVEMENT Skilled nurse training: presentation of peer support activities and explaining your own care pathway A direct quote from a patient’s Customer satisfaction Work at the Bridge ed at the Comprehensive Cancer Cen- Hospital’s model facil- Participation in obser- feedback: Customer satisfaction is measured tre since 2016. In accordance with HUS’s ities to plan the ward vation visits and ward visits. through continuous customer feed- Joint Authority Administration’s 2018 patient room and pa- tient toilet “I received fast and professio- back that patients can submit electron- guidance, and in collaboration with Lau- nal care, and I was notified of ically or on a paper form. Feedback on rea, a two-day patient advisory board changes in time.” care is collected four times a year. Cus- training event was organized to train the tomer feedback was submitted just over 12 patients sitting on the panel for the “Scheduling was carried out fle- 2,000 times in 2018, and over 95% of it Comprehensive Cancer Centre. The task xibly and with consideration for was positive. 99% of respondents would of the patient advisory board is to as- Health Village’s Kun- toutustalo’s (Rehabil- Commenting on the the patient, for which I would li- recommend the Comprehensive Cancer sist, brainstorm and support the plan- itation House) partic- bowel cancer patient ipation in the Breast ke to say thank you. The treat- Centre as a facility. Custom- ning, development and assessment of the care pathway text cancer patient devel- ment was brisk and pleasant, er feedback is evaluated three times a Comprehensive Cancer Centre’s servic- opment project and my visit was hassle-free. year and resulted in the following being es and activities. The patient advisory identified as areas for development at the board aims for the opinions, evaluations, EXPERT BY Comprehensive Cancer Centre in 2018: experiences, perspectives and ideas of EXPERIENCE ACTIVITIES • patients are provided with sufficient patients and their relatives to be con- and understandable information sidered in an organized and increasing- • consideration for privacy protection ly comprehensive manner when planning Lymphedema self- • inspection of signage for the new the Comprehensive Cancer Centre’s ac- care exercise events Participation in the entrance tivities and services. The customer pan- in cooperation with a planning of cancer physiotherapist medication training • good patient interaction experience el helps to make activities at the Compre- hensive Cancer Centre more patient-cen- Patient Advisory Board tered. The patient advisory board meets Speaks about patient HUS Helsinki University Hospital’s first once a month. encounters at training Participation in the events: panel to consist of patients has operat- Magnet Hospital - Student nurses and event, presentation of doctors expert by experience - New employees activities Expert by experience trainer Patient advisory board activities in 2018

Promoting patient- Ensuring that patients and Experts by experience: sional personnel in the development of Visits to units and observations Participation in events centered care their relatives are heard The Comprehensive Cancer Centre’s first services at the Comprehensive Cancer • Presentation of the patient • HUS Helsinki University Hos- • Commenting on patient • Work at the Bridge Hos- 12 experts by experience completed their Centre. Shared expertise; that is, collab- advisory board ’s activities pital patient rights day guidance and patient vid- pital’s model facilities training in May 2018. Training to be- oration between professional person- and familiarization with units’ • Women’s Day at the eos to plan the ward’s pa- activities Comprehensive Cancer • Collaboration with OLKA tient room and sanitary come an expert by experience lasted for nel and experts by experience, produces • Observation visits to units. Centre to organize peer support facilities five months, including seven themed on- a well-functioning and patient-centered Observation targets are se- • Men’s Day at the Com- activities for two wards • Participation in the site training days. An expert by experi- culture of care, which results in an even lected by members of the prehensive Cancer Cen- and for ward 5 at the Day workshop pilot as part patient advisory board . tre Hospital of the Ministry of Social ence’s own experience of cancer, treat- better care experience for the patient and • Observation of signage for • Evaluation of customer Affairs and Health’s ser- ments and living with the disease pro- their relatives. the new entrance feedback and presenta- vice promise vides tools for the development of ser- Units can order experts by experience tion of suggested solutions • Commenting on the • Commenting on the “Cus- Comprehensive Cancer vices and activities. The aim of expert by for e.g. various activity development pro- tomer service with care” Centre’s website experience activities is to make experts jects and training events. presentation by experience equal partners to profes- • Work on the Comprehen- sive Cancer Centre’s pa- tient support presentation

44 45 QUALITY AND PATIENT INVOLVEMENT

PATIENT SERVICES

Digital services ment access times are published on the Noona is used at the A Cancer House and Palliative Care website to ensure no delays. The website Comprehensive Cancer House have been added to the Health also publishes trials that are open to pa- Chatbot answers the most fre- Centre: Village, and they provide lots of informa- tients, and digital care pathways and pa- quently asked questions for • with breast cancer patients tion for patients. You can log in to HUS tient instructions for major diseases. new patients at the Depart- ment of Oncology. throughout the entire care Helsinki University Hospital’s care path- pathway from surgery to follow way for breast cancer patients via the The Noona mobile service up monitoring, Health Village. The patient will receive Noona is a mobile service that allows the • with patients with urologic an appointment letter containing an in- patient to communicate with the care cancers, vitation to the care program, which they team at the HUS Comprehensive Cancer • with bowel cancer patients, must log in to. The Health Village care Centre during treatment and the follow- • with melanoma patients, program provides the patient with de- up phase. Symptom surveys, and oth- • with lymphoma patients, tailed information about each treatment er general treatment-related information • with patients receiving phase, along with patient instructions. where necessary, are sent via Noona be- immunotherapy, and The care program works alongside the fore treatment. Patient responses to the • with Clinical Trial Unit patients. Noona mobile application, providing the symptom survey and other information patient and their relatives with informa- sent via Noona are reviewed daily. The Doctors, nurses and patients at tion. patient’s care team will send a response the Comprehensive Cancer Center A customer service bot, or chatbot, has and treatment instructions via Noona participated in the development been developed to answer the most fre- within 1 – 2 business days. In some situ- of the Noona service. quently asked questions for new patients ations, Noona will identify a set of symp- at the Department of Oncology. The chat- toms and send an automatic response, bot is a computer program that is de- which will be checked by the care team signed to engage in conversation. Chat- later on. bots work by using key words to identify the topic of a conversation. The custom- Advisory services and peer sup- er service bot can be found in the Health port Village’s Cancer House. An OLKA® advice point and an advisor The Comprehensive Cancer Centre al- for the Cancer Society of Southern Fin- so has its own website. The website pub- land both operate at the Department of counters and support in coming to terms Patient involvement in service lishes information such as patient treat- Oncology. OLKA® refers to coordinat- Finland’s first with their disease. OLKA® also provides development ment access times. In 2013 it became the ed organization and volunteering activity patient advisory peer support and information about var- Finland’s first patient advisory board first Finnish cancer hospital to begin to in the hospital. Activities aim to offer pa- ious patient organizations. Information, was established at the Comprehensive measure treatment access times. Treat- tients and their loved ones unhurried en- board support and advice about cancer is avail- Cancer Centre. Patients can also partic- was established able from the advice service nurse at the ipate in the development of activities as Cancer Society of Southern Finland. The experts by experience. The Comprehen- at the service is free for patients and their rel- sive Cancer Centre has pioneered the de- atives. There are electronic information velopment of tailored digital Noona mo- Comprehensive boards in the waiting areas that provide bile services for self-reporting and fol- Cancer Centre. information on news relating to activities low-up that cover the entire care path- at the Comprehensive Cancer Centre and way for cancer patients. HUS Helsinki University Hospital. The Comprehensive Cancer Centre organizes group information for e.g. breast cancer patients before they move on to the fol- low-up phase.

46 47

Research in Comprehensive Cancer Centre

Research Groups HUSin Syöpäkeskus on Key Projects and Funding vahvasti sitoutunut syöpähoitojen parantamiseen tukemalla syöpätutkimusta eri tavoin. RESEARCH RESEARCH

CANCER RESEARCH AT THE HUS COMPREHENSIVE CANCER CENTRE

There has been a monumental improvement in can- Trials sponsored by the pharmaceutical indus- cer survivorship in the past 50 years. Cancer sur- try are important to us and our patients, but par- vival has more than doubled during this time in ticular interest is also given to enhancing academic the developed countries. The main reason for this research, both clinical trials and translational lab- has been the investment in cancer research since oratory research as well as nursing science. A num- Cancer Research at HUS the declaration of “war on cancer” in early 70’s. ber of our cancer center scientists and research Comprehensive Cancer Research has improved survival at multiple lev- groups direct research in laboratories dedicated to Center els, ranging from early detection and diagnostics cancer care. Examples of cutting-edge research em- to surgery and from radiation therapy to design of ployed at our center include individualized systems • 7 professors novel drugs based on molecular biology. The latter medicine and technologies such as Car-T cell ther- • 25 principal investigators has given us examples of drugs that can cure such apies as well as globally unique novel accelerator- • 5 translational laboratory groups advanced diseases that 20 years ago inevitably led based boron neutron capture therapy (BNCT) stud- • Approx. 20 senior investigators and 50 to death. ies. Moreover, cancer diagnostics and treatment doctoral students However, cancer is still the second leading produce a large amount of clinical data. These are • Funding of over 8 million euros in cause of death globally with immense human suf- increasingly exploited in our research using artifi- 2018 fering but also large economic impact. Noticeably, cial intelligence in several research projects in col- • 2 doctoral theses underway in nursing there is a huge variation in survival between dif- laboration with Aalto University researchers. science ferent cancer types. The 5-year survival in testicu- Our research is evaluated regularly by a scien- • A scientific advisory board consisting lar or thyroid cancer is far over 90% while less than tific advisory board (Professors Brian Huntly, Cam- of international experts evaluates our 5% of patients e.g. with pancreatic cancer survive bridge, UK; Roger Henriksson, Sweden; Patrick research regularly. that long. Therefore, the need for cancer research Schöffski, Leuven, Belgium and Pasi Jänne, Har- has not disappeared but in fact increased as finding vard, USA) since 2015 with the last meeting in fall effective treatment for several cancers has become 2018. While the advisory board found the science to more complicated and work-intense. be of high quality, it also noted that the number of HUS Comprehensive Cancer Center is strong- trials could even be higher with increased level of ly committed to improve cancer treatment by sup- external support, particularly relating to personnel. Hundreds of scientific porting cancer research at multiple levels. We per- studies form and advance clinical and translational cancer Panu Jaakkola • An average of 40 new studies are research on a wide scale. We conduct clinical trials Research director launched every year. ranging from first-in-human and other early phase • In 2018, we had 180 ongoing studies trials in our clinical trial unit to larger phase III tri- • Comprehensive Cancer Center als. The trials include novel cancer medicines, ra- produces over 250 scientific diation therapy and surgical trials as well as palli- publications annually. ative and psychosocial care. Clinical trials are im- • Nearly 20% of these are published portant for several reasons. They benefit cancer pa- in high-impact (IF>10) international tients who get more treatment opportunities as well journals. as the clinicians who get early experience on novel treatments.

50 RESEARCH RESEARCH GROUPS

RESEARCH GROUPS: FROM Lymphoma group Professor Sirpa Leppä’s group

www.helsinki.fi/en/researchgroups/ CLINICAL TO TRANSLATIONAL lymphoma-biology-and-survival

The group aims to improve the treat- RESEARCH ment outcomes for lymphomas. The group conducts academic and phar- maceutical industry-sponsored clini- cal drug trials in which the treatment An introduction to the Comprehensive of lymphoma is individually tailored Cancer Centre’s research groups to the patient based on the risk of re- currence and biological properties. The group also examines clinical and biological factors that determine pa- tients’ response and prognosis at Bi- omedicum’s applied tumor genomics research program laboratory. In ad- The individualized treatment of leukemia dition to the group leader, the group Professor Kimmo Porkka’s group (@kporkka) consists of five senior researchers, www.helsinki.fi/hematology seven doctoral candidates, research nurses and bioanalysts. The group aims to develop the mul- individualized treatment of acute leuke- tidimensional characterization of mia. The group also carries out related leukemia (genome, transcriptome, preclinical (biomarkers, recycling) and functional studies, image analysis), early-stage pharmaceutical research. automatic diagnostics and treatment The group consists of three senior re- selection based on machine learning, searchers, two doctoral candidates, and and guidance on how to enable the students.

Oncolytic immunotherapy for the treatment of cancer Professor Akseli Hemminki’s group https://www.helsinki.fi/en/researchg- roups/cancer-gene-therapy-group

The research group develops onc- olytic viruses that can be used to change the immunological environ- The pathogenesis of blood cancers and autoimmune diseases ment of tumors so that an increas- Professor Satu Mustjoki’s group (@HRU_research) ing number of patients with sol- www.helsinki.fi/hematology id tumors can benefit from the an- tibody-mediated modulation of im- The group studies the pathobiology mors with the aim of finding molecu- The group consists of seven senior re- mune responses and other T-cell- of malignant blood disorders (such as lar targets for new and curative treat- searchers, 11 doctoral candidates, and based treatments (e.g. CART, TIL leukemia) and autoimmune diseas- ments. The group combines basic re- students. and TCR). The group consists of two es, as well as the immunobiology of tu- search with clinical drug trials. senior researchers and five doctoral candidates.

52 53 RESEARCH RESEARCH GROUPS Electronic reporting tools for cancer Adjunct Professor Johanna Mattson’s and Adjunct Professor Carl Blomqvist’s group

The group examines the impact of electronic patient reporting The efficacy of antibodies in breast cancer tools on patient preference, satisfaction and compliance, qual- Professor Heikki Joensuu’s group ity of life, symptoms, treatment outcomes, cost of treatment, and the tools’ potential in the development of cost-effective In extensive clinical trials, the group ological research into the mechanism of processes in cancer care. The group consists of four senior re- examines the efficacy of antibodies action of medicines that target the HER- searchers and two doctoral candidates. that target the Her-2 receptor in ad- 2 receptor. The group includes senior re- juvant treatment for breast cancer. searchers and a doctoral candidate. The group also conducts cellular bi- Boron neutron capture therapy Adjunct Professor Mikko Tenhunen, Adjunct Professor Leila Vaalavirta, Professor Heikki Joensuu

Quality of life and rehabilitation Boron neutron capture therapy (BNCT) is a new kind of bi- Professor Tiina Saarto’s group ologically targeted form of radiation therapy to treat can- cer. It can be administered in a single treatment and to ar- Research focuses on the quality of life so examines the impact of art, physical re- eas which have previously received maximum radiothera- and rehabilitation of patients with can- habilitation and palliative care on patients’ py, sparing healthy tissue (page X). In 2019, a new kind of cer and other chronic diseases at var- quality of life and wellbeing. There are sev- BNCT neutron accelerator installed at HUS Helsinki Univer- ious stages of their illness, including en doctoral students in the group. sity Hospital was the first of its kind in the world to be in- at the end-of-life stage. The group al- stalled at a hospital. In its first phase, the study focuses on the efficacy and safety of BNCT in the treatment of advanced cancers for which there are no other treatment options. The BNCT study also collaborates with groups from the Univer- sity of Helsinki to develop new boron carriers and to begin Melanoma research group wider research into the cellular biological effects of BNCT. Adjunct Professor Micaela Hernberg’s group

The research group focuses on factors treatment of melanoma in specific groups. affecting the efficacy and safety of -dif The group consists of two senior research- ferent melanoma therapies, develops ers and five doctoral students. GIST group treatments tailored to the needs of the Professor Heikki Joensuu’s and individual patient, and assesses the Panu Jaakkola’s group

Biomedicum’s GIST laboratory is investigating the biology of the rare gastrointestinal stromal tumor cancer and medicines’ mechanisms of action. The group also examines the effect of Coagulation disorders research group tyrosine kinase inhibitors and radiation therapy on the preven- Professor Riitta Lassila tion of GIST progression in extensive clinical trials. The group consists of three senior researchers and a doctoral candidate. The group’s objective is translation- and the antithrombotic effects of heparin al research, i.e. transferring basic re- proteoglycan are leading to a phase 1 clin- search findings to clinical applications. ical trial through preclinical work. As part Research focuses on new methods of of the new Oncosys research group (RPU), testing blood coagulation and a wide- the group focuses on ovarian, testicular Breast surgery research groups ranging comparison of these methods and pancreatic cancers’ effects on coagu- Professor Marjut Leidenius’s and in current and clinical routine meth- lation and platelets. The group compris- Adjunct Professor Tuomo Meretoja’s group ods to promote the early diagnosis of es three senior researchers, three doctoral coagulation diseases and monitoring candidates, and students who are in the ad- The groups assess treatment practices and surgical proce- of new therapies to ensure patient safe- vanced phase of their studies. dures in the recurrence of breast cancer and in patient surviv- ty. In particular, platelet function tests al. Four doctoral students participate in the research groups.

54 55 RESEARCH RESEARCH GROUPS

Renal cancer research group Rare subtypes of breast cancer and the Professor Panu Jaakkola’s and development of treatment Adjunct Professor Katriina Peltola’s group Adjunct Professor Johanna Mattson’s and Adjunct Professor Carl Blomqvist’s group The group examines clinical and biological factors that af- fect the progression of renal cancer and treatment efficacy, The study focuses on breast cancer in men and very young particularly with regard to immune response modulation women. The group also characterizes rare subtypes of breast therapies. The group consists of two senior researchers and cancer, such as metaplastic and neuroendocrine breast cancer, a doctoral student. in collaboration with Docent Heli Nevanlinna’s laboratory. The Women’s Hospital is collaborating with clinical geneticists to investigate genetic predisposition to breast cancer. Collabora- tion is also carried out with Juha Klefström’s laboratory to take experimental treatments based on breast cancer models to ear- ly-stage clinical trials. The group comprises several senior re- searchers and three doctoral students.

The role of hereditary factors in blood cancers Adjunct Professor Ulla Wartiovaara-Kautto’s and Adjunct Professor Outi Kilovaara’s group

The group examines the genetic mutations occurring in the germline of blood cancer patients, their frequency and the in- teraction of somatic mutations and the blood cell’s growth en- vironment. Research focuses on investigating early biological Soft tissue and bone sarcoma group mutations that lead to blood cancers, and to find forms of treat- Adjunct Professor Carl Blomqvist ment that prevent the occurrence of blood cancers and cause as few late effects as possible. The group consists of four doctoral Collaboration between the HUSLAB Laboratory of Cytomo- lar genetic mutations in sarcomas, changes in DNA candidates and two postgraduate students. lecular Genetics and Pathology, the Department of Oncol- copy number, the clinical significance of changes in https://www.helsinki.fi/en/researchgroups/hematological-genetics ogy, clinic and Orthopedics clinic began in copy number and microchip analyses, and the de- 1987 to systematically recover tumor samples in connection velopment of methods suitable for the examination with tumor surgery. The research team has produced more and treatment of sarcomas. The group consists of than ten doctoral theses and almost 200 high-quality arti- ten senior researchers and six doctoral students. cles on subjects such as chromosome changes and molecu- BOUNCE PhD Paula Poikonen-Saksela’s and Adjunct Professor Johanna Mattson’s group

FinnGen research project BOUNCE is an EU-funded multinational research project that Adjunct Professor Tuomo Meretoja and aims at predicting effective adaptation to breast cancer to help Professor Heikki Joensuu women to BOUNCE back. A predictive tool to assess individual resilience and to tailor individual support will be created to en- FinnGen is an extensive, nationwide biobank study which hance efficient recovery from breast cancer and help patients to aims to produce genetic information from 500,000 Finnish remain in the workforce, cope at home and enjoy a better qual- biobank sample donors. Cancer is one of the FinnGen pro- ity of life. ject’s priorities, and researchers from the HUS Comprehen- sive Cancer Centre, as well as a significant number of its pa- tients, are taking part in the study.

56 57 RESEARCH KEY PROJECTS AND FUNDING

KEY PROJECTS AND X), and boron neutron capture therapy (BNCT), 250 where we will be the first in the world to begin re- search with the current technology. scientific Our investigators have been able to attract sig- FUNDING nificant amounts of national and internation- publications al funding. Our investigators coordinate two EU HUS’s Comprehensive Cancer Centre is the larg- founding and launch of the Southern Finland Na- projects. In 2017, the Comprehensive Cancer Cen- est center for cancer research in Finland. The Com- tional Cancer Center, FICAN South. tre was chosen as the coordinator of a multination- prehensive Cancer Centre performs both clinical In 2018, the Comprehensive Cancer Centre pro- al EU-funded project Bounce, which aims to devel- and translational research concentrating on vari- duced over 250 scientific publications. It is im- op a resilience trajectory predictor of breast cancer ous types of cancer. Research includes both inves- portant to note that a significant number of these, patients. Our investigators also coordinate an EU tigator-initiated studies in academic groups as well nearly one in five, were published in international project for personalized drug therapy of T-cell ma- as cooperation studies with the pharmaceutical in- journals of very high impact factor (>10). Our high lignancies. The project has received funding from dustry. We also cooperate with several national and research activity is also evident in the fact that our the European Research Council (ERC). Several of international research networks. Our investigators investigators work as principal investigators in sev- our research groups have received funding from the participate in large-scale national projects, such as eral multinational research projects concentrating Academy of Finland, Business Finland, and from the FinnGen genetic information project where our on breast cancer, lymphoma, hematology, patients’ various foundations, such as Jane and Aatos Erkko investigators are in charge of the clinical group. The quality of life and rehabilitation, for example. Foundation, Luise och Henrik Kuningas stiftelse, Comprehensive Cancer Centre’s investigators also Annually, the Comprehensive Cancer Centre and Sigrid Juselius Foundation. The Cancer Foun- have an important role in the Academy of Finland’s launches 40 new studies, and in 2018, we had 180 dation Finland has also supported our research iCAN cancer flagship project (Digital Precision Can- ongoing clinical trials, of which over 90 were drug groups with several significant grants in the 2010s, cer Medicine platform). The Division of Hematology trials. Examples of significant contribution to re- most recently in 2018. In 2018, the Comprehensive leads the project for The Finnish Hematology Reg- search include the Comprehensive Cancer Centre’s Cancer Centre produced scientific research with istry and Clinical Biobank, FHRB, and the Compre- new unit for early-phase clinical trials, where sever- outside funding of over 8 million euros. hensive Cancer Centre has had a leading role in the al first-in-human trials are currently ongoing (page In addition to clinical studies, the development of new cancer therapies requires multi-profession- al cooperation between the hospital’s investigators performing clinical studies and the researchers de- veloping new methods of laboratory and IT analy- sis. A great deal of the research in Comprehensive Cancer Centre is performed in Biomedicum’s trans- lational cancer research laboratory, and our inves- tigators cooperate with the translational cancer re- search groups from University of Helsinki, as well as other organisations, such as the Institute for Mo- lecular Medicine Finland FIMM. Digital analysis of enormous amounts of clinical data, artificial intelli- gence in health care development, and software for electronic patient reports will become the next key factor in cancer research. The Comprehensive Can- cer Centre is in charge of several projects related to digitalization in health care. These projects include the Bounce project and HUS’s CleverHealth ecosys- In 2018, the Comprehensive Cancer tem / eCare for Me projects that aim to improve di- Centre produced over 250 scientific agnostics, cost-effectiveness, and patients’ coping publications. with their cancer treatments.

58 59

iCAN

Pathology and the Biobank, FinnGen HUSin Syöpäkeskus on FIMM vahvasti sitoutunut syöpähoitojen Cancer Biology parantamiseen tukemalla Cancer Genetics syöpätutkimusta eri tavoin. Tumor Groups

FICAN South

COOPERATION Syöpäklinikan tuki ry COOPERATION iCAN iCAN

Professor Tomi P. Mäkelä is Executive vo drug screening, and genetic variation Officer of the recently launched iCAN with unique Finnish digital health inputs Digital Precision Cancer Medicine Flag- including those from Helsinki Universi- ship and Vice Director of the Center of ty Hospital HUS datalake, registries and Excellence in Translational Cancer Biol- patient reported outcomes. The platform ogy. His groups interest focuses on cell will be developed within pilots in colon, growth signaling and its deregulation in breast and ovarian cancer as well as he- cancer with special emphasis on the tu- matological malignancies and leiomyo- mor microenvironment and tumor sup- ma with potential to be applied in var- pressor LKB1 signaling. ious other cancer types. HUS Compre- iCAN is one of six national flagships hensive Cancer Center researchers are in Finland 2019-2026 aiming to develop critical participants in iCAN. nuclei of scientific excellence into com- Patient involvement and empower- petence clusters for discoveries, inno- ment at all stages is a key aim in iCAN. Tomi P. Mäkelä vations, and societal and economic im- The University of Helsinki and HUS Hel- Executive Officer, pact. In iCAN a platform joining Digital sinki University Hospital act as founding iCAN Digital Precision Cancer Health and Precision Cancer Medicine is hosts of iCAN aiming to create a com- Medicine Flagship established for discoveries and improved petence cluster with significant long- treatments. term investments from companies in the The iCAN Digital Precision Can- pharma/digital health sector as well as cer Medicine platform integrates liv- other public and third sector partners ing biobanks, immune profiling, ex vi- nationally and globally.

62 COOPERATION PATHOLOGY, BIOPANK AND FINNGEN

MEILAHTI CAMPUS BIOBANK DYNAMIC DIAGNOSTICS AS – PROMOTING THE DIAGNOSIS AND PART OF THE CARE CHAIN CARE OF CANCER PATIENTS Biobanks are an increasingly important resource collected samples, as well as to new samples taken The basic task of pathology is to use mi- niques – such as immunohistochemistry, in modern translational research. Translational re- for diagnostic, treatment and monitoring purpos- croscopy to diagnose cancer from tis- flow cytometry, and molecular genetic search bridges the gap between basic research and es. The biobank will also support hospital districts’ sue and cell samples. However, pathol- and cytogenetic testing – and has led to patient care and enables, for example, individual- research strategies, the University of Helsinki’s re- ogy and genetics have advanced from a the division of cancers into several sub- ized treatment programs for cancer patients. As a search strategies, and regional research strategies. purely diagnostic role to become an inte- types, each with their own prognosis and clinical biobank, the Helsinki University Hospital gral part of the entire patient care chain. care response. For example, in Immuno- Specific Catchment Area’s biobank supports the re- HUSLAB carries out centralized patho- histochemistry, HUSLAB uses a range of search of its member organizations, and networks logical and genetic testing at three dif- 400 antibodies, which is extensive on an with other national and international biobanks. Comprised of regional partners ferent laboratories. Its activities also in- international scale. Meanwhile, the rapid One of its strengths is the collaboration with clin- • HUS Helsinki University Hospital clude field-related research and prod- development of molecular genetics test- ics and research groups that develop cancer treat- • University of Helsinki (HY) An international leader in uct development, which play a key role ing has allowed for the more accurate ments, including the Center of Excellence in Trans- • South Karelia Social and Health District (Eksote) laboratory testing in maintaining cutting-edge diagnostics monitoring of cancers, prognosis assess- lational Cancer Biology. • Joint Authority of Kymenlaakso Social and Health • Around 430,000 tests annually in pathology and genetics on an interna- ment, and individualized, targeted can- The aim is to provide Ethics Committee-ap- Services (Kymsote) • 57 doctors tional level. cer treatment. proved research projects with access to previously • 95 bioanalysts Strong developments in the industry • 23 specialist employees have introduced modern testing tech- • research and development work

THE FINNGEN RESEARCH PROJECT Arno Palotie

Launched in fall 2017, FinnGen is an extensive pub- derstanding of the pathogenetic mechanisms of dis- lic and private sector research project that aims to eases. At the same time, FinnGen allows for the produce genetic information from 500,000 Finn- identification of genetically verified targeted phar- ish biobank sample donors. Cancer is one of the macotherapies and for the development ofnew indi- FinnGen project’s priorities, and researchers from vidual therapies, including for cancers. the HUS Comprehensive Cancer Centre, as well as The Comprehensive Cancer Centre is participat- a significant number of its patients, are taking part ing in the FinnGen study on many levels. The Com- in the study. The FinnGen research project is coor- prehensive Cancer Centre and Helsinki Biobank dinated by the University of Helsinki’s Institute for make up a highly significant share of FinnGen’s na- Molecular Medicine Finland (FIMM), with Profes- tionwide sample collection - patients at the Compre- sor Aarno Palotie acting as Scientific Director for hensive Cancer Centre can participate in the study the project. by giving their consent to providing a biobank sam- The FinnGen study produces genetic infor- ple. Almost 25,000 Finns diagnosed with cancer had mation from blood samples collected by Finnish participated in the FinnGen study by April 2019. Re- biobanks. Combining genome information with searchers at the Comprehensive Cancer Centre also health care data from registries increases our un- lead FinnGen’s group of cancer specialists.

64 65 COOPERATION FIMM

FIMM – THE INSTITUTE FOR MOLECULAR MEDICINE FINLAND

Top International Research Rapid translation of cancer This is based on genomic information • About 250 people, represent- research for the benefit of and functional drug sensitivity testing of ing almost 30 different nation- patients patient cells. The method will also help alities. Operations began in The Institute for Molecular Medi- prioritizing new drugs to be brought for 2008. cine Finland (FIMM) is a translation- clinical trials. In projects on hematolog- • Hosted by the University of al research institute focusing on hu- ical cancers and solid (for example ovar- Helsinki since 2017 one of the man genomics and precision medicine. ian and urological) tumors, precision operational units of the Hel- Collaboration with biobanks and clin- therapy is developed in cooperation with sinki Institute of Life Science ics, particularly with the HUCH Cancer clinicians from HUH Cancer Center. (HiLIFE) Center, is a key part of the institute’s ac- Furthermore, digital molecular pathol- • A Finnish node of the Nordic tivities. ogy is established at FIMM to improve EMBL Partnership for Molec- FIMM is a global pioneer in the de- novel cancer diagnostics based on imag- ular Medicine and a member velopment of personalized precision ing and machine learning. of EU-LIFE therapy for cancer. The institute has de- • Approximately 240 articles in veloped methods for predicting the re- international scientific jour- sponse of cancer patients to therapies. nals published each year • Coordinates the ambitious FinnGen study combining genomic information with digital health care data of 500,000 Finns Mark Daly, the current Director of • Coordinates the Academy of FIMM, is a distinguished scientist who Finland Centre of Excellence has made major contributions to hu- in Complex Disease Genet- man genetics and genomics during his ics and is engaged in the iCAN 20-year career. He was recruited from cancer flagship project the Broad Institute of MIT and Harvard • Integrates the latest technol- and Massachusetts General Hospital to ogy infrastructures, biobanks Helsinki in 2018. He has made seminal and molecular medicine re- discoveries in understanding the details search for patient benefit of the structure of the human genome Mark Daly and developing software tools to analyze the impact of genetic variations on vari- ous diseases, with special interest in au- tism, ADHD and other psychiatric dis- eases as well as inflammatory diseases. He has over 400 scientific publications with over 130 000 citations.

66 COOPERATION CANCER BIOLOGY

CENTRE OF EXCELLENCE IN TRANSLATIONAL CANCER BIOLOGY: PRODUCING GROUND-BREAKING RESULTS

The Centre of Excellence in Transla- creates the foundation for developing tional Cancer Biology is a multidiscipli- more effective, targeted cancer drugs. nary research program that has garnered The centre of excellence studies and numerous international awards for its tests completely new therapy strate- ground-breaking cancer research. The gies for preventing cancer growth and group’s areas of first-class expertise in- spread, and develops new diagnostic clude the function of cancer genes, can- tests and selection methods for cancer cer stem cells, cancer angiogenesis, tar- drugs so that therapy can be optimized SYNTHETIC LETHAL geted drug screening, and translational individually. The centre has had research technology. breakthroughs involving suppression of APPROACHES TO INDUCE Together these areas form a strong tumor lymphangiogenesis and angiogen- Finnish centre of excellence for transla- esis that have already progressed to in- IMMUNOGENIC CELL DEATH tional cancer biology research that also patient trials. AND TREAT BREAST CANCER Kari Alitalo trains experts in this field that is critical The centre of excellence brings to- Juha Klefström Academy Professor for the future. The centre’s goal is to de- gether high-quality research groups velop new therapies with the help of gene from University of Helsinki and Univer- and stem cell research, three-dimension- sity of Turku. The groups are led by eight Klefström laboratory strives to advance research Moreover, they develop and test chemical tools to al cell culture models produced from pa- top cancer researchers and they work in from the bench to early clinical development by fo- explore opportunities in intervention of oncogen- tient tumors, in-vivo research models, close collaboration with VTT Technical cusing on therapeutic strategies aiming to exploit ic transmembrane serine proteases, especially hep- and drug screening. A new type of cellu- Research Center of Finland, HUS Helsin- oncogene-induced vulnerabilities in cancer. Klef- sin. Klefström laboratory has established a vari- lar model enables examining the func- ki University Hospital, National Institute ström has a total of over 20 years of experience in ety of three-dimensional culture systems and pa- tion of molecules discovered through of Health and Welfare, and Turku Uni- cancer biology, including 15 years as an academ- tient tumor-derived breast explant cultures for ex high-quality imaging and testing new versity Hospital. ic lab head and 10 years as a coordinator, leader vivo target validation, drug testing and for studies therapies in an environment that is more Professor Alitalo is known as a lead- and founder of multiple international public-private of breast cancer development. The PI has special physiological in nature than tradition- ing expert and key researcher for his pio- partnerships involving major pharmaceutical in- expertise in breast cancer biology, oncogenes, syn- al cell cultures. By combining research neering work to increase understanding dustries. The laboratory studies therapeutically in- thetic lethal strategies, preclinical genetically en- results achieved via different methods, of pathophysiology of cancer and its me- tervenable metabolic vulnerabilities caused by on- gineered mouse models, ex vivo organoid cultures significantly better understanding can tastases. Consequently, Professor Alitalo cogenic MYC protein, synthetic lethal approaches to and recombinant viral gene/shRNA/CRISPR gRNA be reached regarding cancer metastasis is among the most referred scientists in treat breast cancer and several strategies to boost transfer methods. mechanisms, for example. This in turn Europe. immunotherapies via immunogenic cell death.

68 69 COOPERATION CANCER BIOLOGY

THERAPEUTIC BIOMARKERS FOR TARGETED TREATMENT OF GASTROINTESTINAL STROMAL TUMORS (GIST) AND HEAD AND NECK SQUAMOUS CELL

CARCINOMA (HNSCC) Outi Monni

Despite substantial advancements in the target- peutics. To identify drug response biomarkers and ed treatment of cancer, certain tumors do not re- oncogenic drivers that contribute to the growth of spond to treatment or develop resistance to cur- these tumors, they are exploiting several genom- rent anticancer therapeutics. The gorup’s aim is to ics approaches, patient-derived cell lines and ex vi- explore the molecular genetic characteristics and vo three-dimensional tumor cultures that better putative drug response biomarkers for two cancer represent the original tumor in terms of heteroge- types that are challenging to treat: advanced gas- neity, molecular profile, and drug responses. Com- trointestinal stromal tumors (GIST) that no long- bining the modern molecular biology tools with ex- er respond to other approved treatments as well cellent clinical material and expertise at the HUS as human papilloma virus negative head and neck Comprehensive Cancer Center, they hope to trans- squamous cell carcinoma (HNSCC), for which no fer our molecular findings into the benefit of can- reliable biomarkers exist for the targeted thera- cer patients.

CANCER CELL BIOLOGY GROUP

www.helsinki.fi/en/researchgroups/cancer-cell-biology

Päivi Ojala

Cancer Cell Biology group led by Professor Päi- gamma-2 herpesvirus, as a model system to study vi Ojala Cancer Cell Biology group at the Transla- cancer development and progression. Ultimately, tional Cancer Medicine Research Program (CAN- their studies aim to identify novel signaling path- PRO), Faculty of Medicine, is focused to study the ways and key proteins critical in cancer metastasis role of lymphatic endothelium in the tumor micro- and viral cancers, which could open new leads that environment and its contribution to cancer me- can be pursued for novel intervention and thera- tastasis. The group is interested in the changes in peutic strategies. More recently, they have joined a the tumorigenic properties of the cancer cells up- new collaborative project involving cell-based, pre- on contact with the lymphatic endothelium, and clinical and translational studies with the goal to also in the changes induced in the lymphatics by develop a first-in-man trial of CAR-T therapy of sol- the tumor cells. They are also using Kaposi sar- id cancers. coma herpesvirus (KSHV), an oncogenic human

70 COOPERATION CANCER GENETICS CANCER GENETICS RESEARCH

The Finnish Center of Excellence in Tu- cently made it possible to analyze whole mor Genetics Research combines four genomes, both human and tumor. top research groups. Both benign and Cancer genetics is a key field of medical malignant tumors are a combination of research, in which Finland and this con- two genomes: a person’s own genome, sortium have excellent traditions at the the germline, and the tumor genome. highest international level. The Centre of This setting, further complicated by tu- Excellence consists of four top research mor heterogeneity, is one of the key chal- groups representing multiple comple- lenges in medical research, and multidis- mentary disciplines from epidemiology ciplinary collaboration is a requirement and genetics to bioinformatics and sys- for success in this research field. The dis- tems biology. The groups take advantage covery of significant cancer predisposing of the powerful synergistic combination genes has increased our understanding of advancing technologies, unique na- of the basic mechanisms of malignant tional materials, and sophisticated data tumor growth, and fast development of analysis methods to develop and validate genome sequencing technologies has re- disease models. The end goal is to trans- late the molecular findings into clinical benefits.

Research of the highest level

• Four research groups: two from the University of Helsinki, one from Tampere University, and one from the Finnish Cancer Registry

• Academy of Finland funding for 2018–2025

• 9.4 million euro funding for the first four-year term Lauri Aaltonen

• As of now, there is already one Nature magazine publication by the Center of Excellence, regard- ing transcriptional regulation of the genome, among several other high impact publications.

72 COOPERATION

TUMOR GROUPS

Multidisciplinary care meetings decide on patient-specific treatment. Meetings are held regularly, usually once or twice a week. Multidisciplinary care meetings are attended by top experts in the diagnosis of cancer and in surgical and oncological treatments. The Comprehensive Cancer Centre also has its own multi-professional tumor groups for all cancers which create and update disease- 1 specific treatment recommendations in real time in accordance with new, significant research findings.

Breast cancer Breast cancer is the most common can- cer in women with more than 5,000 women diagnosed in Finland each year. For the majority, the disease is diag- nosed in the early stages (a tumor in the breast and possible metastases in the axillary lymph nodes), and most pa- 1 tients will recover. Surgery is the corner- stone of treatment, after which the re- Group leaders: Riikka Huuhtanen and 1 Katriina Peltola moved tumor is classified and an oncol- ogist plans adjuvant systemic treatment (involving hormones, chemotherapy, or Bowel cancer Gastric and pancreatic cancer anti-HER2 treatment) based on the type Bowel cancer is a cancer that originates in the small Approximately 1,700 Finns are diagnosed with gas- of tumor. intestine, large intestine or rectal glands. Each tric or pancreatic cancer each year. The symptoms The breast cancer tumor group moni- year just under 3,500 new cases are diagnosed, of pancreatic cancer are rather vague, which means tors international developments in breast and bowel cancer is the third most common can- that it often goes undiagnosed until it is at an ad- cancer treatment and actively partici- cer in Finland after prostate and breast cancer. Lo- vanced stage. Treatments for pancreatic cancer in- pates in both national and internation- calized cancer in the intestinal wall is treated with clude surgery, or chemotherapy. al drug trials. The members of the tu- surgery, while rectal cancer is treated with a com- Pancreatic cancer usually refers to adenocarcinoma mor group also act as partners to spe- bination of surgery and radiation therapy. Chemo- of the pancreas, but other rarer forms of cancer can cialist doctors or as consultants at out- therapy can be given as adjuvant therapy after sur- also occur in the pancreas. Gastric cancer on the patient clinics treating breast cancer pa- gery, and in cases of rectal cancer, may also be giv- other hand, originates in the glands of the stomach tients, and they participate in all as- en before surgery in connection with radiothera- lining. The initial symptoms of stomach cancer are pects of the development of breast can- py. Metastatic bowel cancer is treated with a combi- usually mild. Surgery is the key form of treatment cer treatments. The Finnish Breast Can- 2 nation of chemotherapy and new biological system- for localized gastric cancer, but it is most often ac- cer Group works closely with the breast ic treatment. Isolated metastases may also be sur- companied by chemotherapy. Advanced gastric can- cancer tumor group and the investigator- gically removed, especially if they are located in the cer is primarily treated with chemotherapy and, in initiated clinical trials it leads are an im- liver or lungs. some patients, with targeted medication. portant focus area in research, involving patients from all over the world. The tu- mor group collaborates closely with cam- pus researchers on projects such as the iCAN project.

Group leaders: 1 Marjut Leidenius and 2 Johanna Mattson

74 75 COOPERATION TUMOR GROUPS

Testicular cancer Testicular cancer is the most common cancer in young men, with around 170 patients diagnosed in Finland each year. The first symptom of testicular cancer is a swelling or lump in the tes- ticle. The most important form of treat- ment is surgery, which also reveals the subtype (seminoma or non-seminoma) 1 of the testicular cancer. Depending on the subtype of tumor, chemotherapy or radiation therapy are used to treat met- 1 astatic testicular cancer. Residual tu- mors are removed in a surgical proce- dure, if necessary. The prognosis for testicular cancer is excellent, and al- most all patients recover.

Group leader: 1 Susanna Mannisto

Lymphoma Lymphomas are divided into two main types: Hodg- pies, radiation therapy, stem cell transplantation kin’s lymphoma and non-Hodgkin’s lymphoma, or ma- and combinations of these. The lymphoma group 1 ture T and B cell lymphomas. Roughly 1,500 new cas- actively participates in international investigator- es of lymphoma are diagnosed in Finland each year. initiated and industry-commissioned clinical trials. Lymphoma treatment is constantly improving: treat- The Nordic Lymphoma Group works closely in part- ments include chemotherapy, antibodies, cell thera- nership with the tumor group.

Group leader: 1 Sirpa Leppä

Gynecological cancers Around 1,600 women are diag- nosed with gynecological cancer each year in Finland. The majori- ty of these, about 80%, are made up of cancer of the uterine corpus and 1 Prostate cancer ovarian cancer. The primary form Prostate cancer is the most common cancer in men. For metastatic prostate cancer, new hormonal drug of treatment for gynecological can- More than 5,000 new cases are diagnosed each treatments in particular have changed the course of cers is surgery. Chemotherapy and/ year. Localized prostate cancer is treated using ex- the disease and improved the prognosis. Research or radiation therapy can be used as ternal and/or interstitial radiation therapy, surgery is under way at the Comprehensive Cancer Cen- adjuvant therapy depending on the or active surveillance. HDR brachytherapy and hy- tre to investigate e.g. a new form of treatment with cancer’s origin, metastasis and oth- pofractionated radiotherapy are well-established 177Lu-PSMA, which is not yet available in public er predicted factors. treatments at the Comprehensive Cancer Centre. healthcare elsewhere in the Nordic countries. Group leader: 1 Mikko Loukovaara Group leader: 1 Tapio Utriainen

76 77 COOPERATION TUMOR GROUPS

Lung cancer Sarcoma On average, more than 2,600 Finns Sarcomas are malignant tumors of the are diagnosed with lung cancer bone or soft tissue. Sarcomas are relatively each year. Around 80% to 90% of rare, with only around 240 new cases di-

cases are caused by smoking. Lung agnosed in Finland each year. Treatment 1 cancer is usually diagnosed from plans are drawn up for individual patients X-rays and is treated with systemic 1 and may consist of surgery, pharmaco- treatment, surgery, radiation thera- therapy, radiation therapy, or a combina- py, or combinations thereof. tion of these.

Group leader: Aija Knuuttila and Group leader: 1 Riikka Nevala 1 Pauliina Kitti (Radiotherapy)

Brain tumors Neuroendocrine cancer Brain tumors are treated at the Com- Neuroendocrine tumors are rare and can prehensive Cancer Centre with radia- develop in any organ. They are most com- tion therapy, chemotherapy, or a com- monly found in the intestines and many bination of the two. Developments in 1 of them secrete hormones, which cause radiation therapy are reflected in the symptoms that vary greatly from patient 1 treatment of brain tumors, where the to patient. Treatment options include sur- precise planning of therapy is key. gery, systemic treatment, 177-lutetium- Approximately 1,000 brain tumors octreotate therapy or follow-up. are diagnosed in Finland each year, Group leader: 1 Maija Tarkkanen with gliomas and meningiomas being the most common.

Group leader: 1 Päivi Halonen

1 1

1

1

Urinary cancer Melanoma Around 2,000 Finns are diagnosed with urinary Around 1,300 cases of melanoma are diagnosed in cancers – renal or bladder cancer – each year. Uri- Finland each year. The main form of treatment for Head and neck cancers Thyroid cancer nary cancers are more common in men. The main melanoma is surgery, which also removes some of the About 800 new cases of head and neck cancer are Thyroid cancer is more common in women than form of treatment for renal cancer is surgery. The healthy tissue around the melanoma. The Compre- diagnosed in Finland each year, most often in the in men. Around 350 new cases of thyroid cancer treatment of bladder cancer is assessed on an indi- hensive Cancer Centre provides systemic treatment pharynx, larynx, and oral cavity. The main forms of are diagnosed in Finland each year. First, surgery vidual basis, considering e.g. the extent to which the and radiation therapy for melanomas. HUS Helsinki treatment are surgery and radiation therapy, as well is performed to remove the thyroid gland. This is cancer has spread, and varies from superficial instil- University Hospital also provides some special sur- as a combination of these (chemoradiotherapy). most often followed by radioiodine therapy to de- lation, bladder surgery and/or radiation therapy or gical systemic treatment treatments, such as isolated stroy any remaining thyroid or cancer tissue. systemic treatment. Today, new targeted medicines limb perfusion (ILP). Group leader: 1 Venla Loimu are used to treat metastatic renal cancer. 1 Group leader: Päivi Halonen Group leader: 1 Micaela Hernberg Group leader: 1 Petri Hervonen

78 79 COOPERATION FICAN SOUTH AND SYÖPÄKLINIKAN TUKIJAT RY

FICAN SOUTH BRINGS TOGETHER CANCER CARE PROFESSIONALS IN SOUTHERN FINLAND

The Southern Finland Regional Cancer Center FI- are initiating activities. FICAN South has support- CAN South was launched at HUS Helsinki Universi- ed joint projects between clinical and translational ty Hospital in 2018. The Southern Finland Region- researchers as well as joint projects between HUS al Cancer Center comprises HUS Helsinki Universi- Helsinki University Hospital and central hospitals. ty Hospital, the University of Helsinki, which is re- FICAN South has coordinated e.g. the production sponsible for medical research and education, the of the first national FICAN treatment recommenda- Päijät-Häme Joint Authority for Health and Wellbe- tion for bowel cancer, the piloting of an occupation- ing (PHHYKY), the Kymenlaakso Social and Health al therapy model aimed at people diagnosed with Services (Kymsote) and South Karelia Social and cancer as young adults, and the introduction of Health Care District (Eksote). benchmarking for cancer treatment within the spe- The role of the Southern Finland Regional Can- cific catchment area. cer Center, or FICAN South, is to coordinate the di- The southern region’s, or Helsinki University agnosis and treatment of cancer and to promote Hospital Specific Catchment Area’s cancer center cancer research in Southern Finland. The Southern FICAN South is one of the National Cancer Center Finland Regional Cancer Center operates in con- Finland’s (FICAN) five regional cancer centers to be nection with the HUS Comprehensive Cancer Cen- set up in university central hospitals. Other region- tre and collaborates with all parties treating can- al cancer centers are FICAN East, FICAN Mid, FI- cer. A steering group began operating in early 2018, CAN North and FICAN West. and clinical and scientific research working groups SYÖPÄKLINIKAN TUKIJAT RY - AN ASSOCIATION SUPPORTING COMPREHENSIVE CANCER CENTRE

The key aim of the association is to support the pa- Patients in Finland (Suomen syöpäpotilaat ry). tients of Comprehensive Cancer Centre and their The association runs on volunteer work and dona- loved ones during the stressful hospital stay by mak- tions. ing the hospital environment more comfortable. The Board members of Syöpäklinikan Tukijat ry in association regularly maps out the needs of the pa- 2018: Ann Selin (Chair), Risto Kirjalainen (Vice tients together with the hospital staff. How dona- chair), Inge-Brit Barkholt (Treasurer), Eeva Lind- tions are used is decided according to the wishes of Ekholm (Secretary), Minna Anttonen, Maarit Feldt- the patients and their loved ones. The association Ranta, Ulla Kotiluoto, Suvi Laru, Pirjo Lönnfors, also organizes events and publishes information Johanna Mattson, Hilkka Olkinuora, Susanna Son- booklets in cooperation with Association of Cancer ninen, and Marjatta Spankie.

80 81

Training for Physicians

Training for Nurses

HUSin Syöpäkeskus on vahvasti sitoutunut syöpähoitojen parantamiseen tukemalla syöpätutkimusta eri tavoin. EDUCATION EDUCATION

MEDICAL STUDENTS Training for physicians: annual wheel of events

HUS Helsinki University Hospital’s Com- 3-year national project launched in 2018 The philosophy prehensive Cancer Centre is Finland’s to digitize and harmonize medical edu- behind the largest oncology training unit. As a cation in Finland (Medigi) (https://www. teaching hospital it is responsible for the medigi.fi). education is University of Helsinki’s Faculty of Medi- Specialist training is based on guid- 11.1. Finnish Lymphoma the “Master – cine’s basic in oncolo- ed practical work and supplementary lo- 2018 Group meeting gy, hematology and palliative medicine; cal, national and international theoreti- 2019 x.1. January Seminar of for specialist medical education in oncol- cal education. The philosophy behind the 2020 1.–4.12. ASH Annual Nursing apprentice” Meeting ogy and hematology; and for post-grad- education is the “Master – apprentice” 2021 25.–26.1. Seminar for 7.–10.12. ASH Annual resident doctors x.2. EAHAD approach. uate studies in the field. Breast surgery approach. There are 20 doctors training Meeting 14.2. Helsinki x.11. Operative Days is a specialization option in both gener- to specialize in oncology, two of whom 4.–25.1. Seminar for Hematology Day 2.11. Finnish Breast Cancer resident doctors 13.2. Helsinki al surgery and plastic surgery. The pe- graduated as specialists in 2018. Two of Group autumn Hematology Day

riod of residency in breast surgery var- these obtained a doctoral degree. There meeting

U TAM ies from 3 to 6 months. In addition, a pe- were four doctors studying to special- LUKU MIK JOU UU

riod of 1 to 2 months in breast surgery is ize in hematology, and three graduated

U H x.3. EBCC U EL elective for students undergoing surgery as specialists. A log book compiled by the SK M 10.–12.10. ESSO A IK R U 21.–22.3. Finnish Nursing Exhibition R U foundation training. The Comprehen- European Hematology Association (the A M 24.–27.3. EBMT 25.–26.10. sive Cancer Centre also acts as a train- European Hematology Curriculum, htt- 28.–29.3. Radiation therapy seminar National oncology nursing

M ing unit for special qualification in palli- ps://ehaweb.org/education-2/education/ A x.3. St Gallen Early Breast educational days U U A K L Cancer Consensus meeting I ative medicine. european-hematology-curriculum/) was A S

K K

U

O

U

Oncology training is led by Professor introduced in hematology and harmoniz- L x.4. Finnish Breast Cancer Sirpa Leppä and clinical teachers Paula es education both in Finland and in Eu- 27.9.–1.10. ESMO Group spring meeting 20.9. Finnish Lymphoma x.4. Regional training seminar

S

Poikonen-Saksela and Annika Pasanen, rope. Y Group meeting U in hematology Y U

S K K I while hematology training is headed by Theoretical education is organized T x.9. Nottingham Breast U 3.–5.4. Nordic phase I course H U U

Cancer congress H Professor Kimmo Porkka and Head Phy- each week for personnel. Personnel ac- 11.–12.4. Helsinki Lymphoma sician Ulla Wartiovaara-Kautto. Pro- tively organize and participate in nation- 27–29.9. ESSO Advanced Masterclass Breast Cancer Course

x.4. National seminar for

fessor Tiina Saarto is responsible for al and international education. E U L 27.9. Finnish Hematology O U K K residents in hematology U O

training in palliative medicine. Profes- In the spring of 2018, a national clin- Association’s autumn U K U TO x.4. Helsinki Lymphoma

sor Marjut Leidenius and Docent Tuomo ical cancer investigator course was or- seminar Masterclass

14.–15.9. Breast cancer course HE

INÄ KUU Meretoja are responsible for breast sur- ganized and completed by 25 clinical in- K Ä at Tuohilampi UU KES gery training. The Comprehensive Can- vestigators. In February 2018, the tradi- 30.–31.8. Oncology seminar cer Centre’s docents and specialists par- tional Helsinki Hematology Day was held x.8. NordCoag 31.5.–4.6. ASCO ticipate in teaching. Collaboration with and attracted more than 100 practition- 23.5.–25.5. EAPC x.7. ISTH 13.–16.6. EHA x.5. EAPC other university hospitals also takes ers and researchers in the field of hema- x.7. ISTH 13.–16.6. ESH 20.5.–22.5. EAPC place, such as when determining com- tology. 50 doctors attended the national 18–22.6. ICML mon learning objectives or producing Helsinki Lymphoma Masterclass organ- 29.5.–2.6. ASCO and updating learning materials. ized annually by HUS Helsinki Universi- 11.–14.6. ESH Basic education consists of seminars, ty Hospital. 11.–14.6. EHA mentoring and group teaching, and in- Surgeons and oncologists from HUS cludes both theory as well as monitor- Helsinki University Hospital’s Compre- ing and participating in practical clini- hensive Cancer Centre participated as ed- cal work. Teaching makes use of coher- ucators in the international Master of Re- ent teaching methods and digital teach- constructive breast Surgery, Module I: Di- ing materials. There were 150 medical agnostics and Oncology training program Personnel actively organize students in 2018. coordinated by HUS Plastic Surgery. and participate in national The Comprehensive Cancer Centre and international education. coordinated the oncology component of a

84 85 EDUCATION

TRAINING FOR NURSES

Around 150 The Comprehensive Cancer Centre of- sinki University Hospital Specific Catch- fers its nurses the opportunity to develop ment Area. The training model was ex- nursing students at different professional career levels. In tended to include mentoring in 2017 (7 order to achieve OECI accreditation, the credits) and supervisor training in 2018 under- planning of advanced cancer care train- (7 credits), offered to each department go clinical ing for nurses began in 2013 and com- area. In 2018, the planning of advanced plied with the HUS Helsinki Universi- training in palliative care (7 credits) was training at the ty Hospital’s professional career mod- also initiated for nurses working at the Comprehensive el. Training was carried out in cooper- basic and A levels of palliative and hos- ation with the Metropolia University of pice care in the Helsinki University Hos- Cancer Centre Applied Sciences. Proficient-level train- pital Specific Catchment Area. In 2018, ing for cancer nurses (30 credits) began the Comprehensive Cancer Centre par- each year. in December 2014, and Competent-lev- ticipated in the planning and implemen- el training (13 credits) followed in 2016. tation of HUS-wide training for research Radiographers and physiotherapists who nurses (4 credits). treat patients with cancer can also sign A harmonized induction program has up for the training. The training is of- been created for nurses from spring 2018 fered to nurses at HUS and in the Hel- onwards. Nurses’ skills are assessed us-

ing the Nurse Competence Scale (NCS), open-house events are held on e.g. Wom- ured digitally using the Clinical Learn- and radiographers are assessed using the en’s and Men’s days. ing Environment Scale (CLES). The fig- Radiographers’ Competence Scale (RCS). Around 150 nursing students under- ure for the quality of student supervision The Comprehensive Cancer Centre holds go clinical training at the Comprehen- at the Comprehensive Cancer Centre in an annual Cancer Information Day for sive Cancer Centre each year. In addi- 2018 was 9.01 (0-10). The result was the nursing students (≥100 credits) and a tion, there are also Master’s degree stu- second best in the entire HUS. National Breast Cancer Day for nurs- dents in health sciences undergoing clin- ing and physiotherapy professionals. The ical training at the Comprehensive Can- Comprehensive Cancer Centre hosts a cer Centre almost every year. The qual- number of public lectures each year and ity of student supervision HUS is meas-

86 87 www.hus.fi/cancercenter facebook.com/hussyopalaaketutkimus Stenbäckinkatu 9 twitter.com/HUS_uutisoi

P.O. Box. 180, 00029 HUS instagram.com/hus_insta Tel. +359 9 4711 linkedin.com/company/hospital- district-of-helsinki-and-uusimaa-hus-

youtube.com/HUSvideot

441 209 Painotuote HÄMEEN KIRJAPAINO OY 2011