Discipline Hopping: Colorectal Cancer Therapy

One in two people will have cancer during their lifetime. Cancer affects almost everyone whether it is friends, relatives, or the patient themselves. Over the last four decades, innovation in treatment has improved the outcome of many patients by extending life, improving quality of life, and even curing their cancer. However, 28% of all deaths in the UK are still due to cancer. Colorectal (or Bowel) cancer is the fourth most common cancer in the UK, with over 110 cases diagnosed per day. The best-known treatment is surgical removal of the tumour; however, there are challenges to this operation. For example, it is not always easy to remove the entire tumour and failure to do so leads to recurrence. An important clinical need is to improve the surgeon's ability to identify the tumour margins. The other main treatments include radiotherapy, chemotherapy, and immunotherapy. Unfortunately, they are not always successful and might only result in the extension of life or in the worse case have no measurable effect. It is widely recognised that difficult problems require a multidisciplinary approach. Creating new, more effective, cancer treatments is a big challenge, and almost all research funders (charities and research councils) recognise the benefits of multidisciplinary teams to find solutions. However, between the disciplines, there are knowledge gaps, which can slow down progress and lead to solutions to the wrong problems. In this proposed Healthcare Discipline Hopping Award, I will be learning, training, and researching all aspects of colorectal cancer treatment. This will give me the ability to build bridges between the disciplines. To do this I will be integrating with the clinical practice so that I can understand the diagnosis (screening, pathology, and imaging) and the treatment (surgery, radiotherapy, and ablation). I will attend the weekly clinical multidisciplinary colorectal cancer meetings, which decide the treatment plans for each patient. I will observe all of the different CRC surgical operations performed on patients, such as open, robotic, and laparoscopic. This will provide an opportunity to fully comprehend the unmet needs and challenges to surgery, such as determining the tumour margins. I will witness radiotherapy being performed and learn about the limitations and opportunities for further research. I will also find out more about early-stage clinical trials and how basic research is translated i.e. what data sets are required and what are the standards. I will learn about intraoperative ablation treatments and how these could be advanced in the future. I will have access to healthcare economic and healthcare technology assessment experts to obtain a complete picture of the challenges to not only developing new treatment methods but also recognising potential pitfalls from the early stages.

I will be integrating with on-going CRC research projects with clinical partners that are developing various strategies to investigate new treatments. By engaging with projects, I will be learning the key techniques used for in vitro and in vivo evaluation. To broaden my knowledge further, I have planned visits to other medical research centres in the UK, Canada and the Netherlands. Finally, there will be four focussed workshops that will look at the clinical needs of various CRC and other cancer treatments. Members of the groups will include patients, clinicians, scientists, engineers, and industry representatives. Going beyond this award, I will maintain the network of researchers that will be developed during the award.

IIn the long term, cancer patients will receive the greatest benefit from this award. During the award, the ideas and collaborations needed to generate better treatments to improve patient outcomes will be seeded. I will be meeting patient groups and listening to their hopes and concerns and using this information to begin to formulate research ideas that will not only address unmet clinical needs but also consider the patient's needs. Specifically, developing better imaging techniques for surgery will improve the ability to remove the entire tumour and minimise recurrence. This will extend patients lives and provide them with the knowledge that the treatment has a greater probability of success. It is hoped that we can also create research programmes to develop new ways to enhance radiotherapy, and again improve patient outcomes by reducing, or eliminating, the amount of surgical intervention required; thus, improving quality of life, and increasing the life of the patient. Similarly, other treatments, such as photodynamic therapy after surgery, or laser ablation, could be further developed further for colorectal cancer patients. All of the interventions to extend lives and improve quality of life have a benefit to the patient's family members. The National Health Service will benefit in the long term because they will be able to better treat cancer patients. The cost of treating patients with chemotherapy drugs is necessary because it extends lives, but it is also a large strain on resources. Being able to improve treatments so that they are more effective will reduce overall treatment costs. The current average treatment for cost colorectal cancer (CRC) per patient ranges from £3.4k to £12.5k for stage 1 to stage 4, respectively. The UK spends more than £1.6b per year on CRC along, with the total for all cancers amounting to >£9.4b. Enhancing cancer treatments could save the NHS millions. Changes in practice, as a result of research, can have large cost savings while also improving the outcomes. Pharmaceutical and related industries that will benefit from research developments. They will develop products, for example, nanoparticles for enhancing cancer treatments. A relevant UK company for this is Nanoco. Some aspects of the fluorescence-guided concepts are highly relevant to Nanoco and therefore potentially generate jobs and wealth by expanding their products in this area. I will also be contributing to the initial stages of the collaboration with NH TherAguix. Being able to demonstrate enhanced radiotherapy in colorectal cancer would be an entirely new application for this company. If successful, with over 110 CRC patients diagnosed per day in the UK alone, this would amount to significant wealth generation. Students of medical and physical science backgrounds will benefit because they will receive training and experiences from both disciplines from as a result of the 'Hop'. This will include final year projects, but also the formal taught courses will be influenced by what I learn during this award. For example, when I teach Nanotechnology and Bionanoscience I will be introducing clinically relevant elements to provide context. This will help train the next generation of nanoscientists that wish to have an impact on medicine. Finally, I will also be running public engagement sessions throughout the year to inform and engage the public and school children about nanoscience and its application to medicine.