By Integrated Care Journal-
How do we harness innovation to restore cancer services through Covid-19 and beyond? This question found its way under the microscope at the Public Policy Projects Virtual Annual Conference 2020, bringing a panel of experts together to address it.
A diagnostic revamp
The UK has long had comparatively poor diagnostic timeframes for cancer when compared to its’ European neighbours. There is a real concern across the healthcare landscape that this issue will only be exacerbated by the current crisis.
“We simply do not diagnose cancer quickly enough,” opened Professor Karol Sikora, Chief Medical Officer at Rutherford Health, pointing out issues of “delay and disruption” that have routinely hampered our ability to “get the tumour in the bucket” as early as possible. Professor Sikora highlighted recent findings from the British Medical Journal that drew links between delayed diagnosis and a significant increase in mortality.
Returning to ‘normality’ of care provision following the pandemic will only occur with an increase in innovation to supplement services. In the mind of Professor Sikora, diagnostics should be central to any push in oncology innovation.
Where is innovation coming from? Geoff Bellingan, Medical Director Cancer & Surgery Board at UCLH, insisted that innovations around cancer treatment come in many forms. He pointed to a range of innovations that are serving to streamline cancer care and improve early diagnosis.
For example, multi-parametric MRI scanners are being harnessed to innovate endoscopy pathways. “If you get image reporting structured against the biopsy,” explained Professor Bellingan, “you might be able to see that the imaging is so good that you do not need a biopsy. ”
New provisions for innovation in CT scanning technology are also an exciting development. What Professor Bellingan really wants to see is a patient portal whereby data is stored and interoperability is increased across the system. “We need to innovate every angle of care, and we are well placed to do this,” he insisted.
Underpinning our aspirations for the future of oncology is data: How it is collected, how it is used, and how we drive insights from it. Each panellist at the conference sought to stress the importance of data in navigating a way out of the toughest challenge cancer services have ever faced.
Professor Clare Turnbull from the Institute of Cancer Research asked why we have not become more sophisticated in our approach to data modelling, particularly in addressing the mounting backlogs in elective care procedures.
“We need to be able to weigh up on a case-by-case basis who can and can’t have their treatment delayed,” explained Professor Turnbull – who has played a key role in establishing such data modelling at The Royal Marsden specialist cancer centre, providing invaluable insight to inform decision making. Modelling can also be used to calculate staff shortages to surgical capacity, she added.
There is a growing consensus that a widespread examination of our entire approach to data collection is needed. Citing better usage of such data in other industries and indeed in other healthcare systems in neighbouring European countries, Professor Turnbull ventured that data links between primary and secondary care were “quite poor” – this, she insisted, is as simple as not having a blood test result in hospital available to view in a different part of the system.
Someone who certainly agrees with the drive for a data revamp in the NHS is Professor Mark Lawler, Associate Pro-Vice-Chancellor and Professor of Digital Health at the Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast – an internationally renowned scientist with over 30 years of cancer research. “We must use data more effectively than we do at the moment,” he urged, “neither cancer nor Covid respect borders, so why should we? ” Professor Lawler called on providers to create shared approaches to using data: “Data should be the new oil; it should be flowing everywhere. ”
Throughout the course of the pandemic, Professor Lawler has become a keen advocate of using real-time data to calculate the levels of Covid-19 induced disruption to cancer services. His findings have been stark. Seven in ten people with suspicions of cancer were not getting referred in the spring and four in ten were not receiving their chemotherapy treatments. “The question is how do we drive intelligence from our data, rapidly and effectively to meet this crisis,” he added.
Signs of light
While not often vocalised, there are positives to take from this crisis. Representing one of the key technological innovators in this space was Matt Gibson, Head of Diagnostic imaging for Siemens Healthineers. From an industry perspective, Mr Gibson has encountered an NHS that has been forced to “confront technological and organisational issues that have long needed addressing. ” This, he said, has provided the necessary impetuous to try untested digital methods of care – all with the aim of putting patients first.
“What is really coming into play is a major shift in cancer treatment: Where and how it is being delivered. ” The timing is critical, with many patients still deterred from going to hospital. Technology must, then, be harnessed to embed cancer care more closely into the community.
While we are certainly moving towards this goal, Mr Gibson acknowledged that our lack of flexibility when it comes to data remains a stumbling block. On prostate cancer, in particular, the sheer volume of referrals makes consolidating data from disparate sources ever more vital. “We need to use data to give time back to clinicians,” he explained. That being said, Mr Gibson was keen to provide a positive message, stating that he was “massively encouraged by industrial investment as a whole and the impact this has in protecting oncology pathways. ”
Concluding the session on a positive note was David Long, Business Unit Director for Oncology at MSD, who expressed his satisfaction in the tone of the language surrounding oncology at present. As Mr Long concisely expressed: “The patient pathway has never been so much of a discussion point, a standalone topic, and we must continuously strive to improve it. ”
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