Dr Karen Kennedy, Director of the NCRI, had the honour of opening the 2017 NCRI Cancer Conference.
The NCRI is a UK-wide partnership between research funders working together to accelerate progress in cancer research. Collectively, NCRI Partners have funded more than £6bn of cancer research since 2002, and collaboration is key to ensure that these funds are to best effect. Karen emphasised that the only way to capitalise on opportunities and to tackle the considerable challenges facing the cancer research community is through working together in collaboration. Something the new NCRI strategy is built on.
Karen talked through a few examples of partnership working, including our radiotherapy research working group, CTRad. Since its launch in 2009, CTRad has reinvigorated the radiotherapy research field. A newer NCRI initiative, CM-Path, is aiming to reinvigorate the field of pathology research. Recently they have been linking with the Royal College of Pathologists to influence the pathology training curriculum to ensure that the field of pathology is adapting to the new era of genomics. Two papers related to this were published during the conference – read more about these here.
And looking to the future, Karen wrapped-up her talk with a preview of a new ambitious meeting series that the NCRI will soon be launching. This meeting series is set to enable the research community, policy makers and others to come together to pioneer coordinated approaches to emerging advances in research related to cancer. Time to get our thinking caps on for some ideas for meeting topics! Luckily, we have a Conference dedicated to the latest in cancer research for inspiration!
We won’t be able to summarise all of the sessions and research presented at the Conference (there were over 150 talks!), but here we share some of the prominent themes of research that emerged.
New technologies improving cancer research, diagnosis, treatment and care
Technological advances are supporting great progress in technologies used in the lab to study cancer.
Matthew Ellis (USA) presented his team’s work on breast cancer genomics, working to understand how cancer functions, not only on a genetic level, but right up to the activation of the proteins that actually carry out the work inside the cell – an approach called proteogenomics.
In the past, proteogenomics was hindered by the level of technology available that allowed researchers to look at which proteins were being expressed in a cell.
Today the technology is so advanced that researchers can now look at a wide spectrum of proteins that may be contributing to how the cell functions, and, importantly for the work of Matthew Ellis and colleagues, which proteins are allowing a cancer cell to escape treatment by commonly used therapies. Excitingly, technology is advancing to the point where, in the future, it could be routine practise to look at these activated proteins in each patient to develop their treatment regimes. Technological advances are also improving the way that we use existing technologies to diagnose and monitor cancer.
Sally Barrington (UK) gave a fantastic overview of how positron-emission tomography (PET) and PET combined with computed tomography (CT) scans can be used in lymphoma. She showed that PET CT is better at finding the disease than the traditional method of bone marrow biopsies, meaning that patients are more likely to get the appropriate treatment and don’t have to undergo painful biopsies.
Matthias Eiber (Germany) talked us through the increasing use of Prostate Specific Membrane Antigen (PSMA) as a target for PET compounds in prostate cancer. It seems we can spot recurrent prostate cancer with a new PSMA targeting PET compound, which the current PET compounds would miss and, importantly, routine PSA testing would also miss. Matthias highlighted some new PSMA targeting PET compounds that can be used to treat the cancer as well by delivering radioactivity directly to the tumour wherever it is in the body. There are also compounds that can find metastatic legions in lymph nodes allowing surgeons to remove them.
Sarah Bohndiek (UK) spoke about non-ionsing radiation imaging techniques, such as magnetic resonance imaging (MRI) and ultrasound. Particularly amazing was Sarah’s work on photo-acoustic imagining where she uses ultrasound to detect light induced changes in tissues – this allows her to get an image of an organ or a tumour (in mice) that also shows the level of blood oxygenation in different locations. It seems possible to distinguish the tumour from normal tissue and it allows for real-time monitoring of the changes in oxygenation.
Better therapies are also now possible thanks to advances in the technologies that are available to healthcare settings.
Around half of all cancer patients will receive radiotherapy as part of their cancer treatment. Whilst radiotherapy techniques today are incredibly sophisticated, proton beam therapy is the latest and most advanced evolution of radiotherapy, and it has the potential to provide even more targeted treatment.
However, as with all newer technologies there needs to be an evidence base for its use. In his plenary session Anthony Zeitman gave a salutary talk on the dangers of embracing a new technology before the evidence is there and the market forces that can be allowed to take over decisions on health care delivery in the absence of that evidence.
Central to the development of this evidence base in the UK is the NCRI’s radiotherapy research initiative, CTRad, that supports the development and delivery of radiotherapy research. CTRad has already set up a workstream to look at the development of Proton Beam trials and will be at the forefront of coordinating the evidence that will be needed if we are to change practice.
Lifestyle and cancer: Prevention and treatment
In 2012, 14 million people were diagnosed with cancer worldwide. By 2030 the numbers are estimated to be around 22 million. Some of this increase is due to an ageing population, but lifestyle factors also have a big role to play. These include the well-known effects of tobacco, which accounts for around 19% of all cancer cases, and links between cancer and obesity, alcohol use and lack of exercise.
Annie Anderson’s plenary talk asked: Lifestyle and cancer – who really cares? After listening to her talk, delegates were clear that there are plenty of reasons to care greatly about this issue.
Annie emphasised that there is a huge body of evidence to support more emphasis on services and research that seeks to address these risk factors. She called for opportunities for cost effective advocacy, action and support for reducing the risk of cancer occurrence and recurrence by lifestyle changes to be funded and explored as urgently as the quest for chemopreventative agents.
In a separate symposium, three researchers shared their research investigating specific lifestyle interventions and their effects on people who had already developed cancer.
Jennifer Ligibel (USA) outlined the development of her ongoing trial testing whether a telephone support service can help women across the USA and Canada with breast cancer to lose weight and whether this reduces the risk of the disease recurring. We learned that there have been many obstacles to overcome and the trial provides a good example of how to conduct research on this topic.
John Saxton (UK) talked about his ongoing trial to see if hospital supervised or home-based exercise ahead of surgery for bowel cancer can improve outcomes and quality of life for patients. It was interesting to hear that exercise had positive side effects, such as giving patients a sense of control, when they have lost control of their lives following a cancer diagnosis.
Rune Blumhoff (Norway) is interested in dietary factors that dampen inflammation and oxidative stress – two factors involved in the development of cancer. Phytochemicals, high levels of which are found in plant based diets, can dampen inflammation and oxidative stress in mice. Rune is now looking to see if the same is true in humans. The trial will follow patients for 15 years to fully test if an initial diet intervention improves patient outcomes.
Putting people at the heart of research
The NCRI involves patients and carers in all aspects of its work (we call them Consumers), and the NCRI Cancer Conference is no exception, with sessions designed to share their experiences with researchers. Patient Involvement and patient-centred research was also forefront in other sessions, too.
The Conference is home to the flagship NCRI Consumer event, The Dragon’s Den workshop.
Each year we invite researchers to submit proposals that they feel would benefit from input from people who themselves have been affected by cancer. The selected proposals are then pitched to small groups of knowledgeable and trained patients and carers who have had experience of working in research development through the NCRI Consumer Forum.
This year, ten researchers pitched their ideas at ten groups of Consumers. These research proposals spanned a huge range of topics, from the use of radiation drug combinations to looking at the influence of poverty on diagnosis.
As ever, the NCRI Consumer members gave each researcher a wealth of practical advice on common issues such as recruitment, acceptability to participants, the sorts of questions they may like to include and the best ways to disseminate the results. If past Dragon’s Den workshops are anything to go by, the Consumers will have also helped any ensuing applications become more likely to get funded!
Patient advocate and member of NCRI’s Consumer Forum, Roger Wilson, opened an informative session on Quality of Life by highlighting some of the issues he feels are preventing the systematic collection of quality of life data and the effect that has on preventing true patient-centred care.
Roger proposed that the phrase ‘patient-centred care’ is not actually a true reflection of what happens; he says that the care patients currently receive is treatment centred, and to shift this thinking we need better data on the effect that treatments have on quality of life.
Central to this is a ‘big data’ approach, where high quality longitudinal data are collected systematically in a way that makes it easy to compare between treatments and diseases and impossible to hide side effects.
One organisation that plays a huge role in this is the European Organisation for Research and Treatment of Cancer (EORTC), and Andrew Bottomley, Head of QoL at EORTC gave the next talk in the plenary session; providing delegates with an overview of the work he has lead in producing tools to measure quality of life. Melanie Calvert then followed with an informative talk about some of the barriers to the use of patient reported outcomes (PROs) and how we can get PRO tools out into the community to produce high quality evidence and inform patient care.
John Ware, wrapped-up the session with a thought-provoking talk on how PROs have become a vital tool not only in research but also cost effectiveness in health care planning.
Irene Higginson opened her plenary session on palliative care with a sober statistic: projected deaths from cancer in England and Wales will rise from around 144,000 a year in 2014, to around 209,000 a year by 2040.
Irene highlighted that meta-analysis of relevant studies and other key research studies of early palliative care show that it helps improve quality of life, probably reduces depression and may even also improve survival. A recent study shows that early palliative care saves health and social care costs.
Having shown that research in palliative care improves patient experience, saves health and social care costs and may even improve survival, Irene finished by calling for more of it to happen. This is something that the NCRI has also been working on – we have previously highlighted that there is not enough research relevant to living with and beyond cancer, including palliative care, and we are currently running a new initiative to help increase research in the area.