< Previous | Contents | Next >

CANCER IN SCOTLAND: ACTION FOR CHANGE

08. SUPPORTING RESEARCH AND DEVELOPMENT

DESPITE THE IMPRESSION OFTEN CREATED IN THE MEDIA AND POPULAR PRESS, "BREAKTHROUGHS" HAPPEN RARELY AND ARE OFTEN ONLY RECOGNISED IN RETROSPECT.

For example, the potential for the human genome project and related research will be realised only gradually.

Science is already central to modern health care, having generated dramatic improvements in survival rates for childhood cancer, developed new keyhole surgery techniques and currently providing a step change in research into genetic causes of major diseases. Each time we walk into a modern hospital we benefit from decades of scientific research and innovation. But the process from invention to adoption can be slow and we need to be able to introduce proven benefits more rapidly across the NHS.

• Our National Health identified the need for a Technology Transfer Office to help to disseminate good ideas within NHSScotland.

Amongst Scots, survival has improved significantly over the last 30 years for most types of cancer. Securing continuing improvements in cancer survival requires continuing and sustained efforts across a number of fronts. Better awareness and prevention, earlier diagnosis and better, faster treatment all have a part to play in reducing both the incidence of cancer and the deaths it causes. Research will remain necessary in all of these areas as well as into its causes and treatment. It is only through such research that we will continue to steadily improve outcomes for people with cancer.

But large-scale research is costly and good co-ordination with other research funders, including cancer charities through the new UK National Cancer Research Institute is essential. We will do this by seeking to build new partnerships with the main cancer charities to ensure that our research portfolios are complementary and that each body's finite resources are invested to secure maximum benefit for patients.

Prevention

Our understanding of cancer has often been gained only painfully slowly because the link between cause and effect may only become apparent after many years and research often needs to be able to draw on very large patient populations to be confident of the results. Pioneering work on the link between cigarette smoking and lung cancer is such an example. Skills in epidemiology are essential to our understanding of the causes of cancer so that we can do more to help prevent the disease.

• We therefore aim to enhance epidemiology research, encourage more opportunities to develop a research career in epidemiology in Scotland, and to create a dedicated environment in which long-term questions can be pursued.
• We wish to establish a centre of excellence able to forge strong international research collaborations, involving existing experts. This should allow more rapid progress to be made and maintain Scottish research at the forefront of this field. We will be seeking views on how this can best be achieved.

Treatment and care: clinical trials

There is significant evidence that outcomes are improved for those patients treated in environments where research is the norm or for those patients who are involved in cancer trials. At any one time there is a wide range of new treatments and novel drugs being tested in the NHS to establish whether they offer benefits over the current standard therapies. Developments in the provision of care in fields such as nursing, pharmacy, palliative care, radiotherapy, chemotherapy, physiotherapy, radiography and other professions allied to medicine also require to be researched and implemented when evidence is available.

Except for patients with haematological malignancies (particularly childhood leukaemia), few patients with cancer currently participate in clinical trials. For example only 3.4% of patients with colorectal cancer enter randomised trials, the results of which help to shape future improvements to therapies and provision of care.

RECRUITMENT TO CANCER TRIALS IN SCOTLAND: 1997

Source: Scottish Cancer Registry

We want to ensure that more patients have the opportunity to be involved in clinical trials.

• The CSBS core principles for cancer care include the aim of increasing involvement with clinical trials for cancer.
• We will be consulting about appropriate targets for patient recruitment to trials.

Although there is UK-wide recognition of the value of increasing patient involvement in clinical trials, it is also recognised that running trials to high and common standards is costly and creates significant amounts of extra work, especially in smaller centres. In the past this has tended to discourage participation. A national network of Cancer Centres has been initiated in England that will seek to address this issue. However, in Scotland, mechanisms to support clinical trials already exist.

• More recently, longer term increased funding has been agreed for SCTN which will in future be more closely integrated with the registration system for cancer and therefore able to provide a greater level of support than previously.
• This will ensure that the recognised excellence of this data set is exploited to best effect for the Scottish population. It will also help Scotland and its research community to contribute more effectively to developing a national network of cancer research units in the UK where the high quality of the Scottish data set is acknowledged.

For the future

Scotland is internationally recognised for its research at the forefront of biotechnology. The current rapid developments in our understanding of our genetic make up and its role in disease will have major implications for the NHS. It will shape the ways in which future treatments and services are planned and provided. It can also be expected to greatly improve our understanding of why some people are susceptible to a disease, while others in similar circumstances are not.

There are other clear themes for research emerging from our comprehensive health information and statistics programme. We must seek improvement in survival for some of the cancers which are most frequently diagnosed in Scotland, including cancers of the lung, pancreas, oesophagus, head and neck and ovary. Novel approaches should be explored for prevention and treatment, of which current examples include vaccines for the prevention of cancer of the cervix and for the treatment of leukaemia.

Epidemiological research should continue into uncovering the risk factors for cancer and ways to prevent it. The main risk factors are known: smoking and diet. But what precisely are the components of diet that are harmful or protective? Even when health messages are well recognised, changes to behaviour can be slow. We need to understand this process better; for example how can we get people to stop smoking (or not start) and eat more fresh fruit and vegetables? The interaction between known causes of cancer, deprivation and the environments in which people live also require further research.

We also need to know more about the effectiveness of drugs to prevent cancer. Some are already being investigated but this is a field worthy of more study. Earlier detection of disease will also improve outcomes and screening trials are underway. Results will be reviewed by the National Screening Committee, as described in Chapter 3.

What the Scottish Executive is doing

• The Chief Scientist Office is seeking to change the way it supports research by establishing managed research portfolios in priority areas such as cancer and palliative care. The content and approach to commissioning research within each portfolio will be determined through consultation with the research community, but there will be a strong emphasis on building research capacity as well as commissioning new studies.
• The Public Health Institute for Scotland (PHIS) will play a significant part in helping us shape the research agenda for improvements in cancer prevention.

Views on the priorities for the cancer research agenda will be constantly gathered and reviewed.

Genetics and cancer

The human genome project promises new methods for early detection of cancer and the delivery of more effective treatment better focused on the tumour, and with potentially fewer side-effects. Major Cancer Centres throughout the world are already beginning to use DNA analysis of tumours to predict response to chemotherapy. Other research groups are using gene testing to predict the risk of developing tumours and yet others are using genetic approaches to treat cancer. Scotland must position itself to be aware and take advantage of these developments.

• The Genetics Sub-Group of the Scottish Cancer Group will maintain a watching brief on developments and alert us to their possible implications.

< Previous | Contents | Next >