Developing a personalised approach to cancer treatments
Written by Dr. Hakim Yadi and Dr. Louise Jones
Dr Hakim Yadi is an expert in translational medicine at PA Consulting Group and Dr Louise Jones is Head of Translational Research and Stratified Medicine Service Delivery Lead at Cancer Research UK.
As our understanding of the genetics of cancer has developed, there has been much discussion about the potential to use genetic information for personalised or stratified treatments. However, for this to become a reality for all patients, the NHS in the UK needs to develop an effective national molecular diagnostic capability. Cancer Research UK has built a partnership with the NHS, healthcare industry, and the clinical and research communities to create an approach to large scale genetic testing for cancer.
The Stratified Medicine Programme
Phase One of the Stratified Medicine Programme will work with a number of hospitals and labs to demonstrate on a small scale how the NHS can provide molecular diagnosis for all cancer types routinely. It will also discover if this information can be linked to patient outcomes to build knowledge about the interaction between genes and treatments. The programme will focus on six different tumour types: breast, bowel, lung, prostate, ovary and melanoma. Patients will be asked their permission for surplus tissue from their diagnostic tumour sample to be sent to one of three leading NHS genetic testing labs, where DNA will be extracted and analysed for a range of molecular faults linked to cancer. This information will then be linked to details of their treatment and outcomes in a central secure NHS data repository, for access by researchers.
The programme is a partnership between Cancer Research UK, Astra Zeneca and Pfizer and the industry is interested in the potential of stratified medicine, and specifically the opportunity to identify patients for clinical trials and to develop new genetic treatment hypotheses. Alongside this, the government is investing in stratified medicine through the Technology Strategy Board (TSB), the UK's national innovation agency. The TSB’s Stratified Medicine Innovation Platform has committed to a £50 million investment over the next five years to drive the creation of new technologies to support the delivery of stratified medicine in the UK.
“Cancer patients deserve affordable, high quality tests delivered on time, and researchers need more information to link genes, treatments and outcomes,” says James Peach, Director of Cancer Research UK’sStratified Medicine Programme. “Our programme hopes to demonstrate both of these things and we have built a strong partnership across the main stakeholders: the pharmaceutical and diagnostic industries, the NHS, and the Department of Health.”
Challenges facing the diagnostics industry
Diagnostic products will be at the heart of the future of stratified medicine and have the potential to change the business model of pharmaceutical companies, as the era of blockbuster mass usage drugs is replaced by medicine targeted on specific populations. We cannot yet justify or afford sequencing every individual’s genome before a visit to the doctor. However stratification, based on common mutations, is already used in the treatment of the genetic subgroups in breast, lung and colorectal cancer. This approach to treatment will only grow as understanding of the genetic mechanisms of disease increases and James Clough, VP, Oxford Gene Technology believes that new technology platforms for genomic analysis offer enormous potential for the NHS to dramatically improve patient outcomes in cancer.
The challenge the industry faces is keeping up with the rapid pace of discovery of new disease indicators. Dr Paul Denny-Gouldson, from IDBS, believes that one way to do this will be to encourage collaboration within the diagnostics industry to ensure that the industry reaches a consensus, or at least drives interoperability around the technologies used to diagnose disease. Other issues will include the requirement for diagnostics to be more readily available at the point of care; have a rapid turnaround and provide easily useable outputs for clinicians to use during diagnosis. The challenges are daunting but the interest from the medical diagnostic sector is encouraging. Tom Burr, R&D Manager at Source Bioscience, appreciates that initiatives such as the Stratified Medicine Programmeprovide industry opportunities to not only test the current state of the art but also to work together to develop new tools.
The Future: Beyond oncology
Dr Cathy Kelly is the medical director of Aridhia, a healthcare informatics company currently working with the programme. She believes that similar approaches could be applied in the diagnosis of central nervous system and cardiovascular diseases. In both cases there is high disease prevalence and insufficient diagnostic tools for early illness detection or disease prevention.
The ability to develop tests to stratify patients in disease areas outside of cancer will require new business models that promote and appropriately reward collaboration between pharmaceutical, diagnostic and bioinformatics companies. Developing these models will be instrumental in allowing all the existing stakeholders to thrive in this new environment.
The Cancer Research UK programme is the first step on this journey, offering an opportunity to learn and develop these capabilities throughout healthcare systems, opening new market opportunities for medical device companies able to meet these challenges.
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.