Professor David Ball’s first impressions of Peter MacCallum Cancer Centre were mixed.
It was 1973, and a young Dr Ball had moved from Adelaide to Melbourne to embark on three years’ training in radiation oncology.
He walked into the austere corner-block building - since knocked down and replaced - on Little Lonsdale Street which was an early site for Peter Mac.
“I would have no hesitation to say it was one of the worst public hospital buildings that I’ve ever worked in,” Professor Ball says.
“But I think my first memory was the way in which the patients were managed by tumour specific streams – that was a revelation to me.
“A patient could see their gynaecological oncologist and surgeon in the one clinic, without having to go across town.
“That teamwork, and focus on the patient, was a revelation … and what I learned straight away was it’s the people that make the organisation, and not the building.”
Professor Ball is retiring from patient care after a career spanning more than 45 years – much of this time devoted to lung cancer, both treating patients and conducting cutting-edge research.
He has directly cared for an estimated 20,000 patients and his research has contributed to a revolution in treatment that is saving and extending lives for lung cancer patients around the world.
When Professor Ball became Director of Peter Mac’s Lung Service in 1981, lung cancer was considered incurable.
Treatment back then was about pain relief and palliative care, and the field was “kind of stuck there”.
“What occurred to me was there were other cancers we could cure with radiation – cancers of the cervix, Hodgkin Lymphoma was a big success story, cancer of the larynx and so on, not only could you cure them with radiation you could preserve the anatomy, unlike surgery,” Professor Ball says.
“I said ‘why can’t we do that with lung cancer?’ and so we embarked on a more aggressive approach.”
His research - particularly clinical trials using high-dose precision radiotherapy - has led to more than 200 papers published in peer-reviewed medical journals and more than 200 presentations at national and international scientific meetings.
Accolades have also followed and in 2011 Professor Ball received the Merit Award of the International Association for the Study of Lung Cancer, and the Gold Medal of the Royal Australian and New Zealand College of Radiologists.
In 2012, he received the Tom Reeve Award for outstanding service to oncology from the Clinical Oncology Society of Australia.
In 2019, Professor Ball was made an Officer in the Order of Australia and in 2020 he was made an Honorary Fellow of the American College of Radiology in recognition of his “global impact in lung cancer care”.
“During his leadership tenure, Peter MacCallum Cancer Centre’s lung service has developed from a purely clinical service into the most active, internationally recognised and productive multi-disciplinary lung cancer research group in Australia,” ACR president Dr Debra Monticciolo said earlier this year.
Professor Ball says the treatment revolution was made possible by new technology.
PET scans arrived in the 1990s - and then PET/CT in the 2000s - allowing lung tumours to be precisely located in the body, and radiotherapy machines became ever more accurate and able to pinpoint tumours with high-dose radiation.
New targeted drugs also arrived along with immunotherapies that harness that patient’s own immune system to fight their cancer.
Professor Ball expects the next wave of gains to come from better combined use of radiation plus these emerging treatments, meaning “you can reduce the intensity of each treatment so it is not as toxic”.
“I couldn’t have walked into this speciality at a better time because everything has happened,” Professor Ball says.
“We’ve gone from a situation where no patients could be cured and now certain categories of lung cancer can be controlled by radiotherapy 90% of the time.
“It’s been a complete turnaround and I’m so glad it has occurred in my lifetime, and I haven’t had to wait to see the fruits of that gradual learning experience.”
Professor Ball has a message for the current and next generation of clinician researchers, saying while the job is increasingly complex it was vital to “put yourself in the patient’s shoes”.
“Never neglect that empathy and your ability to put yourself in the place of the patient,” Professor Ball says.
“But I also want to encourage enquiry - always try and improve outcomes, not just in the sense of curing cancer but reducing toxicity.
“For a lot of cancers we can cure today, I still think the toxicities are not insignificant, and they leave patients with long-term complications.”
The next chapter for Professor Ball will still include research – in an advisory capacity – but there will be more time to spend with family.
He has four children and now twelve grandchildren – the latest a six-month-old in Singapore who Professor Ball is yet to meet due to the pandemic.
Through his extensive career, Professor Ball has also watched Peter Mac grow and he has followed the hospital through two relocations.
After Little Lonsdale Street, in 1990 Peter Mac's operations were consolidated in a new site in St Andrews Place and then in 2016 into the purpose-built Victorian Comprehensive Cancer Centre building in Parkville, on the edge of Melbourne's CBD.
“We’ve gradually moved from an environment which was depressing for patients, I’d have to say - in spite of the camaraderie and good morale at the old Peter Mac it wasn’t a joyful experience for patients to go into 481 Little Lonsdale Street,” Professor Ball says.
“Now we’re in this beautiful new hospital which I think shows respect to patients … It shows patients we do care about you – you are important to the community.
“It also reflects the high standard in which care is delivered, and we’ve always had that.”