Data and Personalised Cancer Care at The Christie

26 October 2018
By Professor Chris Harrison
Medical Director (Strategy)
The Christie NHS Foundation Trust
Professor Chris Harrison, Medical Director (Strategy), The Christie NHS Foundation Trust

Cancer care is undergoing a revolution. This is being driven by data and our rapidly growing ability to target tumours very precisely.  At the same time, technology is making cancer care much closer to home, and the collection of real-world outcomes data is enabling us to introduce new treatments faster than ever before.

Making treatments more precise and personal is a constant theme in cancer service innovation and in the issues that cross my desk as medical director of The Christie.  I see this in developments which aim to assess an individual’s risk of cancer, detect pre-clinical disease, assess the likelihood of treatment response, target therapy more precisely, asses an individual’s care needs or tailor packages of care to promote recovery.

But discovery of new therapies is not enough.  The real challenge is to spread the innovation beyond the immediate reach of the Christie to ensure consistent and equitable implementation so that the best cancer treatments are available to all.  At The Christie we are in a unique position to do this because our main hospital and academic campus is also the hub of an extensive network of specialist oncology services covering 15 locations in Greater Manchester and Cheshire (over 3 million catchment population).   In addition to the main site we provide a combined radiotherapy and chemotherapy service at two networked centres and a chemotherapy only service at 12 networked locations including one primary care site and four sites served by a mobile chemotherapy service.  This Christie network model drives our belief that that high quality specialist care and local accessibility can go hand in hand.

Our proton beam therapy centre is an example of some of the extremely precise radiotherapy treatments now available and is part of a spectrum of technologies that allow radiotherapy to be targeted at the site of the cancer avoiding healthy tissue that surround it.  Combined with other advanced radiotherapy techniques this means that we are able to provide a full range of radiotherapy treatments tailored to the needs of individual patients.  The networked model means that many of these advanced techniques can be made available locally to patients, slashing travelling times and improving outcomes for patients from some of our most disadvantaged communities.

The Manchester Centre for Cancer Biomarker sciences has particular expertise in the development of “liquid biopsies” for cancer.   It is now possible to identify circulating tumour cells or tumour DNA in ordinary blood samples.  This opens up exciting possibilities for diagnosing cancer through blood tests before the cancer has caused symptoms or for detecting relapses in previously treated patients. This is set to be one of the crucial game changers for cancer care over the coming decade.

Something else that is changing is the way that we classify cancer.  Where once we described cancer mainly in terms of the affected part of the body we increasingly look for ways in which cancers from different parts of the body make similar genetic signals and are therefore likely to respond to similar treatments.  Major advances are being made by bringing together the ability to detect cancer cells and DNA in the blood with tumour genetic analysis so as to identify clinical trials targeted precisely for individual patients.

Perhaps most exciting of all is our growing ability to collect data from these innovative approaches and from patients undergoing standard therapies in real time. In partnership with industry we are developing a system to capture real time real world clinical outcomes data. This incorporates live inputting of clinical data including genomic data together with live inputting of side effects and patient experience.  From a scientific point of view we can track changes in tumour biology and patient response, from a clinical point of view we can give patients real time data on their personal prognosis and from a patient perspective we can bring together data on survival and quality of life to enable truly informed choices.

This is a truly momentous time to be involved with cancer care and a perfect moment for the publication of the Reform paper. When asked to comment on the things that had changed most in the 40 years that I have been involved with the NHS my three choices were that care had become “much more personalised, precise and outcomes focussed”. I could have added that prevention now plays a much bigger part.

Thanks to Reform for this timely paper. It is a real stimulus to thinking and a reminder that the new national cancer plan must not only sow the seeds for innovation and discovery but also ensure that we have the mechanisms for rapid and equitable implementation across the UK.

Making treatments more precise and personal is a constant theme in cancer service innovation