Professor Turi King:
Hello and welcome. You are listening to the Be Part of Research podcast. I am Professor Turi King, your host, and today’s podcast is about cancer.
Every two minutes, someone in the UK is diagnosed with cancer, and there are over 375,000 new cases of cancer each year. Lung cancer is by far the most common cause of death in the UK, followed by cancers of the bowel, prostate and breast. Combined, they account for over half of those diagnosed.
Cancer research over the past few decades has been vital for progressing methods of diagnosis, treatment and care, and joining me today is Professor Jonathan Wadsley who is a clinical oncologist and the NIHR national specialty lead for cancer radiotherapy and imaging research.
So Jonathan, we know that a person’s risk of developing cancer depends on a number of factors including genetic factors, age and lifestyle. Is research telling us any more detail about those risk factors, but also how we can mitigate them?
Professor Jonathan Wadsley:
Absolutely, thanks Turi. So, we do already know an enormous amount about the risk factors behind cancer, both inherited but also perhaps more importantly modifiable risk factors such as, for example, smoking and obesity. So we know that about 30% of cancer deaths are directly related to smoking, and in fact, in lung cancer about 80% of deaths are related directly to smoking. Similarly with obesity, we know 7-8% of all cancer deaths are probably related to people carrying excess weight.
So I think the really important research questions at the moment are what can we do about that, how can we perhaps target those people who have these risk factors to screen them to detect the cancers that they might develop at an early stage when they’re more treatable, and perhaps even more importantly, how can we help to modify behaviours so that people no longer have those risk factors, so help them to stop smoking. And they’re all important areas of research that are ongoing at the moment.
Turi:
I mean, that’s pretty incredible: such a high percentage of lung cancer is down to modifiable behaviour. We have such a role to play in those risk factors. So how do we help people in terms of making those changes?
Jonathan:
Well, that’s absolutely why research is needed, because it’s not straightforward. It’s not as easy as just saying to people, “You need to stop smoking.” We know it’s much harder than that for people, so working out which interventions are really going to support people to be able to do that, motivate them and to help them to understand the risks that they’re subjecting themselves to is absolutely invaluable. And that’s why many sorts of research, both academic/scientific research, but also a lot more behavioural/psychological intervention-type research, qualitative research, is really helpful in investigating those things as well. So a really diverse range of types of studies that we need to do to work out how we best help people.
Turi:
So the field of cancer research is huge, but is it possible to highlight some of the main research breakthroughs from the past few years?
Jonathan:
I think in terms of the treatment of cancer, one of the biggest advances has been in the development of what we call immunotherapy. So these are treatments that stimulate the patient’s own immune system to fight the cancer, often alongside more conventional treatments like chemotherapy.
In a number of cancers, trials that have been run in the UK supported by the NIHR and across the rest of the world indeed, have shown real value to this treatment for particular groups of patients. So, particularly in lung cancer and melanoma (skin cancer) we’ve seen really exciting responses to these treatments, and patients for whom there was really no hope before living many years with these cancers. So I think that’s perhaps been one of the most exciting developments.
Turi:
That’s really interesting. So essentially, you’re training your immune system to go, “These are cancer cells. Get rid of them.”
Jonathan:
Exactly.
Turi:
Yeah. So how does that work?
Jonathan:
Well, we know that many cancers develop ways of evading the immune system, and that’s how they grow and become cancers. Essentially, the treatments block those mechanisms that cancer cells have to evade the immune system, to allow the immune system to do its job and destroy the cancer cells.
We know that there are remaining challenges. Even in the groups of patients that stand to benefit from these treatments, not everybody does benefit, and we need more research to work out which patients are going to benefit from these really very expensive drugs, and which patients are we just wasting time and money giving them those treatments. We need to find better treatments for those patients that they still don’t work for, and also really importantly, we need to do research to work out how we optimise the treatment.
So, these treatments may go on for many months and even numbers of years, with patients having to return to hospital for ongoing injections. It’s great that it’s working and controlling the cancer, but obviously there is expense associated with it, there are side effects associated with it, and inconvenience for patients. So, really important NIHR-sponsored research is currently looking at what is the necessary duration of these treatments? How long do we need to carry on? Can we give shorter treatment duration but still get the same level of benefit, for example?
Turi:
Mm, so this is where research is really important, because it helps you to find what’s the balance in this, in terms of the correct dosage, the best way to do this.
Jonathan:
Exactly. And how do we best avoid side effects? Because with any treatment, there inevitably will be side effects that have an adverse effect on quality of life.
Turi:
So what impact have these findings had on those living with cancer?
Jonathan:
So, as I’ve said, for a proportion of patients with these cancers like lung cancer and melanoma, it really has transformed from the cancer being an absolute death sentence and survival of only a small number of months into patients being able to be long-term survivors and living numbers of years, and in some cases, even being cured of cancers where there was just no hope of that before. So, in these small areas and small subgroups of patients, it made an absolutely massive difference.
Turi:
We sometimes hear it said that cancer is no longer the death sentence it once was. Is that your view, and if so, what part does research play in making that the case?
Jonathan:
Sadly, it depends very much on the sort of cancer we’re talking about. There has been huge progress in numbers of cancers, so breast cancer is perhaps the best example. Breast cancer is a very common cancer, and we know as a result of studies into optimising treatments, so surgery, radiotherapy, chemotherapy, newer drug treatments, survival rates have improved dramatically over the last 30 years, and we’re now in a situation where almost 90% of women with breast cancer live five years and therefore we can reasonably assume they’re likely to have been cured.
Sadly though, with other cancers, so lung cancer, pancreatic cancer (one of my areas of interest), we’re doing much less well. For those cancers, we know fewer than 20% of patients survive five years. The outlook is still very poor, and there’s a need for much more research to find better treatments for those groups of patients.
Turi:
So, you’ve said breast cancer’s had this massive leap forward in survival rates. Is that because it’s a cancer that’s had a lot more research than other cancers?
Jonathan:
The reasons behind the differences are complex. Part of it is the nature of the disease and the effect it has on patients. The cancers with poorer prognosis do tend to be harder to study, just because the patients are more poorly with the cancer. But we know there are also inequities in funding for research, for example, and we know breast cancer research typically is very well funded. Historically, research into pancreatic cancer hasn’t been so well funded. So, it’s not as straightforward as just the money, but there are differences, yes.
Turi:
Can you give some examples of the types of research that’s currently happening in the UK?
Jonathan:
Yeah, so really a very wide range of different types of research. Probably most importantly, as I touched on earlier, is research into an area we know is screening, early diagnosis and prevention. So really, ideally trying to stop people getting cancer in the first place, but if not stopping them getting it, diagnosing them at a really early stage when it’s much more treatable.
And an example of this running at the moment is a study known as the Galleri trial, which is being supported jointly by NHS England and the NIHR, and this is testing a new blood test that might be able to detect at a very early stage not just one cancer but a range of different sorts of cancers. So that’s a really exciting project.
I guess right at the other end of the spectrum, we run what we call ‘early phase trials’, testing new molecules in patients with very advanced cancers who’ve run out of conventional treatment options, for whom there is nothing else to offer. But again, there’s some really exciting new treatments coming through that may offer hope to those groups of patients.
In between that, there are other trials looking at trying to optimise treatments that we already know are beneficial, but we don’t know how best to use it. So, examples of that sort of research in my area of radiotherapy: we’ve looked at the number of different doses of radiotherapy that we need to give to patients and actually, recently one study has found in breast cancer, rather than having to give 15 treatments, we can actually give the treatment in just five treatments, which is obviously much more convenient for the patient but still delivers as good outcomes.
So yeah, a wide range of different things going on.
Turi:
Yeah, it sounds incredible. It’s everything from prevention right through to early diagnosis right through to what are the best treatments. I mean, it’s such a wide way of research, really.
Jonathan:
And of course, also really importantly, perhaps more observational, qualitative-type research to understand better people’s experience of cancer treatments and how we best support them going through what’s obviously a devastating diagnosis and a really difficult time in their lives. And that sort of research is equally valuable.
Turi:
Jonathan, what’s next for cancer research?
Jonathan:
Well, I think the big push at the moment needs to be on this area of screening, prevention and early diagnosis. As I said earlier, we know a lot about the risk factors are. We don’t, perhaps, understand so well what to do about them or how best to encourage people to either avoid those risk factors, or if they’ve been exposed to them, how we best then monitor them to help them have good outcomes if they are unfortunate enough to develop cancer. So, looking at ways that we can target screening to populations that are at risk, looking at behaviour modification, and looking at new technologies like this blood test that I mentioned. I think that’s how we’re going to make the biggest difference to stopping people suffering from cancer.
Turi:
I mean, that is the well known thing, isn’t it? The earlier you diagnose a cancer, the more likely it is that someone’s going to survive it. So, that sort of thing just sounds incredible, to be able to be screened for something and it picks up early on… that would be a game changer.
Jonathan:
Potentially, it would. We do know though that it can be a bit of a double-edged sword and there isn’t always necessarily value in doing that, and that is why it’s really important that we do thorough research to prove the value of these new technologies. If we find that people just know about their diagnosis of cancer earlier but it doesn’t actually change the ultimate outcome, that may actually be a bad thing because they’re just living with knowing they’ve got cancer for longer. So that’s why it’s absolutely vital that we do high-quality research to really prove what the value is and prove that these interventions actually are making a meaningful difference to patients.
Turi:
So, for people listening who may want to get involved, can you explain a bit about the different types of studies that people can get involved in?
Jonathan:
Well, as I’ve said, there’s a huge range of studies depending on your particular circumstances, ranging from screening studies that almost anybody in the community could take part in, through to very niche studies looking at very rare subgroups of rare cancers. We have thousands of these open in the UK, supported by the NIHR, for patients with cancer or to look at preventing cancer.
Many studies will be targeted at particular populations of cancer patients, looking at how we best treat them. And increasingly, studies are even more targeted, so rather than being for any patient with breast cancer, it will be for patients with a particular sort of breast cancer at a particular stage or with a particular genetic change. Because cancer medicine is becoming more personalised, our studies are becoming more targeted and specific to particular populations of patients.
Turi:
So what might they be expected to do if they’re accepted onto a study?
Jonathan:
That would depend very much on the nature and the type of study that they were being asked to take part in, but the first step would always be to gain adequate information about what’s involved. So, that would involve being provided with very detailed written information, and usually also having the opportunity to meet with a member of the study team, often a research nurse, to chat through exactly what’s being done, what the ask would be, what the commitment would be, what the benefits or risks of taking part in the study would be.
And it’s important to say that taking part in a clinical trial is always a voluntary thing. We don’t coerce people into it, but would hope to be able to have a conversation to determine whether it’s something that’s the right thing for you.
Turi:
So it sounds like it really varies depending on the kind of study, but what really comes across is that everyone is supported through the process.
Jonathan:
Absolutely, and we work very hard to make sure that patients are well supported. And I think that’s one of the real benefits actually of taking part in research, is that often it means that you have better support and closer monitoring than you would do if you were receiving routine care. Because we think it’s so important that people who are willing to give their time and take an element of risk, I guess, to take part in the study are well looked after and well cared for.
Turi:
So what are the different types of studies that people can get involved in?
Jonathan:
So really, there are many, many different sorts of studies that we run. We’ve talked about the screening studies, and that just involves giving a blood test that we then analyse. We may be doing studies testing new treatments, new drug treatments or new ways of giving radiotherapy for instance.
But also, really important qualitative studies. So I’ve recently been involved in a study looking at trying to investigate why patients experience so much fatigue after they’ve received treatment for cancer, and that just involves an interview and filling in some questionnaires to help researchers understand what it is that causes the fatigue and how we might be able to better help to alleviate that.
So, really a very wide range of different things that we investigate.
Turi:
I suppose, the other thing is that it’s not just in hospitals either that people can take part.
Jonathan:
No, absolutely. We’re keen to reach as wide a population of people as possible. It’s really important that we have a wide and diverse population of people taking part in research, that we know that the findings that we then generate are generalisable and applicable to our whole population.
So I guess an example of something that I’ve been working on recently is in a screening trial, looking at patients being screened for bladder cancer. And we know that patients who are at risk of developing bladder cancer are often from more economically deprived backgrounds, perhaps not so able to access or visit hospitals, so we’re looking to deliver that trial actually in general practices closer to where those patients are, to make sure that it’s accessible to the people to whom it’s most relevant.
Turi:
Mm. So how do people find out about what research is happening near them?
Jonathan:
So, for people who are already cancer patients, the most straightforward way is almost certainly to ask your doctor or your specialist nurse, the team looking after you, because they will know obviously in detail about your particular circumstances and which studies are open locally that might be relevant to you.
However, beyond that, the NIHR have a brilliant resource known as Be Part of Research which is a website where you can go and search for relevant trials close to you. So, just enter your location and your illness, and it will show which studies are running near to you, and you can then take that information back to your doctors to generate further discussion about whether you could be referred on to be considered for that.
Turi:
I don’t know if people realise it, but having people when they’ve taken part in my own research, I have been so incredibly grateful, because what they’re doing is helping us, themselves, future patients enormously. So, to have this opportunity to do this and for people to take part, I think is just hugely important really.
Jonathan:
Absolutely. So we are hugely grateful and I do personally always make a point of thanking people for being willing to take part. I have to say, for many patients as well, they’re very grateful to do something that they feel is going to benefit other people.
One of the illnesses I look after is a particularly aggressive form of thyroid cancer for which there is very little treatment available, and we’re running a study asking patients to just donate some tissue, a biopsy that’s already been taken from their cancer, to allow us to do other research. And I think that’s been one of the most positive things for that group of patients. People are just so glad to know that, although their outcome is likely to be poor, the information about them may help other people in the same situation in the future. And that’s just been such a positive thing that people feel that they’re at least maybe giving hope to others. It’s been a really positive thing to offer.
Turi:
So if there’s one thing you wanted people to remember from this podcast, what would it be?
Jonathan:
I think the key message is that doing clinical research is absolutely vital to delivering high-quality healthcare. We’ve seen this through the pandemic. This is why we have vaccines, why we’re able to meet face-to-face today, even. So doing research is good for you as a patient – we know patients who take part in research have been outcomes – but it’s also good for the community, for patients in the future, because it’s the way that we generate better treatments moving forward.
Turi:
Thank you for making this podcast possible and sharing your experiences with us.
We hope you enjoyed listening. If you’d like to read the show notes for this episode or listen to other podcasts in the series, visit the Be Part of Research website.
