Cancer evolution & improving patient outcomes: big topics at NCRI2016 conference
I've been at the biggest UK cancer meeting this week to hear about the latest research and to join in on the discussion of how we can improve patient care. Find out more about the meeting here.
This week, the National Cancer Research Institute (NCRI) cancer conference saw scientists, doctors, patient representatives, funders and policy makers come together to discuss how we can improve the care and outcomes for cancer patients.
The NCRI is a membership organisation that works for a strong cancer research environment in the UK by promoting communication, coordination and collaboration. I spent two and half days in autumnal Liverpool sharing ideas with lots of people – including other charities, researchers and patients – hearing the latest scientific advances, and attending workshops on how we can change our systems and processes to make faster progress.
Here I’ll sum up a couple of the key themes and thought-provoking sessions I went to.
Tackling cancer’s complexity
Many of the scientific sessions dealt with trying to get a handle on the biological complexity of cancer. We learnt more about how cancers evolve over time, with different pockets of cells picking up different gene errors, resulting in a extremely diverse disease. This could hold the key to why some treatments fail, why some cancers come back after treatment and why relapsed disease is usually hard to treat.
Not all drugs are right for all patients (credit U.S Food and Drug Administration)
To tackle this, we will need to target treatments at the right gene faults – the specific ones driving the disease – and to combine the right therapies based on an individual patient’s biological profile. This complexity can also be turned into a weakness – a fascinating lecture by Professor Reuben Harris from Minnesota, USA showed that hitting the signals that promote the evolution of cancer could block its growth. We heard how single targeted drugs rarely cure a cancer, but the intelligent use of drug combinations could selectively hit the cancer from all sides and leave it with no escape route to relapse.
You can read more about our work to tailor treatments for blood cancers here.
Taking innovations from bench to bedside (and back again), faster
One important area is to make sure the route from discovery in the lab to use in the clinic is as smooth and efficient as possible. One interesting workshop focused on enhancing the uptake and spread of research findings into NHS practice. We heard common themes from researchers about the challenges, such as funding for clinical trials, navigating ethical and regulatory processes, getting the right evidence, and the cost of new treatments and devices. A panel made up of regulators and policy makers discussed some possible solutions, but the main theme was to join up thinking and promote early dialogue between all relevant parties.
We need to accelerate research findings into NHS practice (credit Wellcome Images)
There was also a lively session on the role clinical trial units (CTUs) – specialist academic units that design and deliver clinical trials – in optimising clinical research. Professor Pam Kearns, director of the Birmingham CTU, highlighted the need to integrate clinical trials and laboratory research to make sure the trials we run are rational, have the greatest chance of success and that we learn about why some patients don’t respond as well as others so that we can design better treatments for them. She used the example of a clinical trial for children with relapsed acute lymphoblastic leukaemia that, based on a laboratory analysis of gene faults in these patients, is testing whether using a targeted drug originally developed for other cancers is effective for this hard-to-treat disease. The trial has robust and reproducible ways of measuring biological indicators, again based on good quality laboratory research, which should help doctors predict and monitor a patient’s response to treatment.
A theme that cropped up in a number of sessions was the use and reuse of data. Many explored the benefits of data sharing – maximising the outputs of research, ensuring the transparency and robustness of results, and futureproofing our research, amongst others – whilst recognising the need for patient consent, robust ethics and oversight, and safeguarding against inappropriate use. The main message was the need for good governance and regulation, as well as involvement of patients from the outset when designing new systems or processes.
You can read more about our initiative to accelerate innovations here.
Professor David Currow from Adelaide, Australia, gave an engaging lecture on symptom control in cancer patients, especially for those with advanced disease. He emphasised that many treatments, such as pain killers and nausea relief, don’t have the same level of robust evidence on their effectiveness as treatments for the disease itself. He also showed that asking structured questions about symptoms such as pain, rather than an open-ended question like “how are you feeling?”, is better at capturing the true nature of a patient’s experience.
He finished with a call for research efforts into developing new treatments for better symptom control, rather than relying on repurposing existing medications. There were also sessions exploring the challenges and opportunities in the language we use when talking about cancer, how to meet the psychological needs of cancer patients, cancer survivorship and long-term side effects, and new treatments for cancer-related loss of weight and appetite. It was great to see patients and carers speaking in these sessions and putting forward questions from the audience. If we are to ensure patients live well with and beyond cancer, the cancer research community will need to understand and address these issues.
We presented a poster on our work to better understand the needs of patients, with this one focusing on the experiences of patients on “watch-and-wait”.
You can read more about the whole programme to map patient need here.
You can read more about the work presented at the conference on the NCRI website.