Gordon McVie

Understanding the impact of public policy on cancer research: A bibliometric approach

With global spend on cancer research from the public sector now in excess of 14 billion euro, as well as the increasing burden of disease in market economies and low-middle income countries through changing demographics (ageing and population growth) cancer is now one of the most complex and global public policy issues. Using novel bibliometrics we have sought to investigate changes in research activity (total output), relative commitment and collaborations between countries/regions with similar healthcare and population and development parameters - United Kingdom, France, Germany, Canada and Sweden - to assess the utility of this policy research approach by analysing two different cohorts (1995-1999 and 2000-2004) to study the impact of changes on research publications as a surrogate for overall research activity.

Development of interactive empowerment services in support of personalised medicine.

In an epoch where shared decision making is gaining importance, a patient’s commitment to and knowledge about his/her health condition is becoming more and more relevant. Health literacy is one of the most important factors in enhancing the involvement of patients in their care. Nevertheless, other factors can impair patient processing and understanding of health information: psychological aspects and cognitive style may affect the way patients approach, select, and retain information. This paper describes the development and validation of a short and easy to fill-out questionnaire that measures and collects psycho-cognitive information about patients, named ALGA-C. ALGA-C is a multilingual, multidevice instrument, and its validation was carried out in healthy people and breast cancer patients. In addition to the aforementioned questionnaire, a patient profiling mechanism has also been developed. The ALGA-C Profiler enables physicians to rapidly inspect each patient’s individual cognitive profile and see at a glance the areas of concern. With this tool, doctors can modulate the language, vocabulary, and content of subsequent discussions with the patient, thus enabling easier understanding by the patient. This, in turn, helps the patient formulate questions and participate on an equal footing in the decision-making processes. Finally, a preview is given on the techniques under consideration for exploiting the constructed patient profile by a personal health record (PHR). Predefined rules will use a patient’s profile to personalise the contents of the information presented and to customise ways in which users complete their tasks in a PHR system. This optimises information delivery to patients and makes it easier for the patient to decide what is of interest to him/her at the moment.

Development and psychometric testing of a breast cancer patient-profiling questionnaire

Introduction The advent of “personalized medicine” has been driven by technological advances in genomics. Concentration at the subcellular level of a patient’s cancer cells has meant inevitably that the “person” has been overlooked. For this reason, we think there is an urgent need to develop a truly personalized approach focusing on each patient as an individual, assessing his/her unique mental dimensions and tailoring interventions to his/her individual needs and preferences. The aim of this study was to develop and test the psychometric properties of the ALGA-Breast Cancer (ALGA-BC), a new multidimensional questionnaire that assesses the breast cancer patient’s physical and mental characteristics in order to provide physicians, prior to the consultation, with a patient’s profile that is supposed to facilitate subsequent communication, interaction, and information delivery between the doctor and the patient. Methods The specific validation processes used were: content and face validity, construct validity using factor analysis, reliability and internal consistency using test–retest reliability, and Cronbach’s alpha correlation coefficient. The exploratory analysis included 100 primary breast cancer patients and 730 healthy subjects. Results The exploratory factor analysis revealed eight key factors: global self-rated health, perceived physical health, anxiety, self-efficacy, cognitive closure, memory, body image, and sexual life. Test–retest reliability and internal consistency were good. Comparing patients with a sample of healthy subjects, we also observed a general ability of the ALGA-BC questionnaire to discriminate between the two. Conclusion The ALGA-BC questionnaire with 29 items is a valid instrument with which to obtain a patient’s profile that is supposed to help physicians achieve meaningful personalized care which supplements biological and genetic analyses.

Highlights from the ecancer Future Horizons in Lung Cancer conference, 1–2 September 2016: Focusing on the future of treatment for NSCLC and SCLC

The ‘Future Horizons in Lung Cancer’ meeting was designed to bring leading scientists together alongside clinicians to discuss the most recent advances in lung cancer pathophysiology and treatment. The aim was to take those attending the event on a journey through decades of lung cancer research and understanding, with topics spanning from screening and surgical care to “omics” approaches for drug target and biomarker discovery. There were also several talks describing the role of radiotherapy in lung cancer and advancements in imaging techniques, aiding surgeons in their attempts to resect early lesions. Current standards of care were both challenged and celebrated, while new and innovative immunotherapies also came into the spotlight. The meeting, held over two days, attracted a high calibre of speakers and delegates from across the globe. There were 10 sessions in total focusing on the latest therapeutic advances and predictions for the future of lung cancer treatment. Highlights included a key note lecture from Dr Frances Shepherd packing 40 years of lung cancer research into a 40-minute presentation. Heated debates were had regarding the validity of maintenance therapy and immune checkpoint inhibitors that have taken the research community by storm. The latest developments in imaging, surgery, systemic and radiotherapy were presented over 10 sessions of exciting, innovative and stimulating presentations, leaving the audience lively yet pensive.

A web-based interactive tool to improve breast cancer patient centredness

The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient’s unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient–physician communication, improving the patient’s understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient–physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient’s profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient’s physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient’s answers in real time and send them, together with specific recommendations to the physician’s computer immediately before physician’s first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient’s profile). The proposed approach is supposed to improve the patient–physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment and personalisation of care.

PACE Continuous Innovation Indicators-a novel tool to measure progress in cancer treatments.

Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about ‘progress’ and ‘value’ in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes ’value’ to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to accelerate and maximise progress against cancer.

EurocanPlatform, an FP7 project of the European Commission-first year commentary.

EurocanPlatform is an exciting collaboration between Europe’s top cancer centres to accelerate the pace of taking new scientific results to the patients’ bedside. This is being achieved by building shared platforms between the partners in each critical area of cancer research from causation of cancer to delivery of novel therapeutic strategies in clinical trials. The first year of EurocanPlatform has been remarkably free of glitches. Most work packages are up and running well, inevitably a couple are getting up to speed now. The first general assembly at the end of the first year was exciting and rich in content. More than a dozen talks outlined work in hand, and outlined future plans. The most stimulating aspect was the obvious willingness of scientists from the various member institutes (23 in all) to open their technological cupboards, and in the true spirit of the project share know-how and facilities with colleagues. Several innovative hypothesis driven trials were presented by scientists, not clinicians - probably the most remarkable memory of the meeting. And the spread of the platforms from aetiology of cancer through prevention to clinical cost efficacy was abundantly evident. On the former topics, cancer risk assessment and prevention, two projects were discussed and supported. The first was exciting as it harnessed new technological areas, epigenetics and metabolomics to populations, normal, or at risk. IARC in Lyon is looking for epigenetic markers of early cancer using large cohorts, while the EPIC study, the largest global prospective study of diet and other lifestyle factors will be exploited to hunt patterns in metabolomics, which might also prove to be useful early signals of cancer or premalignancy. The EPIC study has recruited over 520,000 volunteers and over 2000 incident cases of lung cancer have already been noted. The intention is to take biological specimens (plasma/urine) and use high resolution mass spectrometry to unravel the molecular patterns in low and high consumers of foods of interest. In parallel, the food metabolome will be assessed with particular attention to those substances, and interactions between these and other biometric parameters will be tested for utility as future biomarkers. Also in the area of biomarkers, Oslo (OCCC) and Milan (INT), covered extensively the molecular profiling of normal, premalignant and cancerous tissue samples from lung, ovary and pancreas. Preliminary findings on 419 glycan-related genes have been presented. The same team leads an ambitious project to refine the technology of identifying and exploiting circulating tumour cells (CTCs). The early application of this technique has shown that numbers of tumour cells retrieved from blood samples correlate with tumour bulk, and changes in numbers have mirrored response to therapy, and subsequent regrowth. Finding small numbers of circulating cells in early disease such as breast cancer has so far been disappointing, but second generation technology is being used by several groups in the consortium and better sensitivity and selectivity are confidently predicted. If one regards CTCs as easily accessible “biopsies” of tumours it is immediately apparent how useful they might be to provide information of metastatic potential, resistance to therapy, and eventual sensitivity to new targeted molecules. First however the group is planning to retrieve gene signatures from CTCs to check whether they are identical or not to the parent cancer. Gene profiling has been achieved so far on as few as 50 CTCs, so this approach looks promising. The translational nature of the EurocanPlatform was confirmed by description of two hypotheses driven clinical trials mooted by Amsterdam (NKI), Paris (Curie), Paris (IGR), Cambridge (CRUK), Barcelona (Val d’Hebron) and London (ICR), each based on collaborative laboratory projects amongst the partners. They include an early phase trial of a dual PI3K/mTOR inhibitor together with tamoxifen to reverse hormone resistance in metastatic breast cancer patients whose cancers are HER2 negative and Estrogen receptor positive. Then there is a plan for a test of the new Braf inhibitor Vemurafenib, shown to be effective in melanoma patients whose tumours display a mutation in BRAF V600E, but in colorectal patients instead of melanoma. It seems that bowel tumours treated with an inhibitor of this mutated gene switch on EGFR which is the target for a number of agents including cetuximab, so a combination of the two agents is logical to trial. The sharing of platform technology know-how, and open access to partner institute facilities is the very essence of EurocanPlatform. A number of collaborations have already been initiated thanks to the project, including kinome resequencing (particularly in ovarian cancer) and refinement of RNAi technology led by Amsterdam (NKI), SNP genotyping led by Cambridge (CRUK), and Reverse Phase Protein Arrays (RPPA), led by Paris (Curie). The interlinking of clinicians and scientists has clearly been achieved already in the project, the sharing of technologies amongst scientists is evident, and the cross talk between clinical epidemiologists expert in prevention, clinicians and scientists, especially focussed on biomarker development bodes well for the future positive impact on cancer patient outcomes. The outreach and dissemination of the results of the project are the responsibility of an ongoing Education programme led by Bari (IT), and the public and professional communications are the responsibility of ecancer.org. The following organisations are also involved in EurocanPlatform: the European CanCer Organisation (ECCO), European Organisation for Research and Treatment of Cancer (EORTC), the European Cancer Patient Coalition (ECPC) and the Organisation of European Cancer Institutes (OECI).

Lessons from the first ecancer symposium on angiogenesis in gastric cancer.

In March 2015, ecancer hosted a symposium at the European Institute of Oncology in Milan, Italy on the topic of angiogenesis in gastric cancer. During this meeting, leaders in the field focused on the latest research on the topic of angiogenesis in gastric cancer, delivering lectures combined with interactive question and answer (Q & A) sessions and a roundtable discussion with the meeting’s chairs. Topics covered included biomarkers, imaging, and the current state of antiangiogenic drugs in gastric cancer. This report will provide an understanding of the relevance of angiogenesis in gastric cancer research, and clinical experiences from diverse perspectives.

A golden anniversary: highlights of the 50th annual meeting of the American Society of Clinical Oncology

The 50th Annual Meeting of the American Society of Clinical Oncology showed a shift in the culture of cancer research, moving towards multidisciplinary, integrated, and patient-centric work. Hormone-sensitive cancers were particularly highlighted at this meeting, and impressive strides were made in the previously underserved areas of the lung and thyroid cancer. Interestingly, immunotherapy was one of the strongest themes to emerge.

Meeting the current and future challenges of oncology drug development

This breakout session highlighted four distinct perspectives from leading individuals within patient advocacy, industry, an appraisal committee and physicians on the future and challenges faced by targeted therapy in HTA evaluation. Bringing together leaders from key stakeholders in the process, it gave participants the opportunity to examine how the same HTA evaluation process is interpreted from multiple perspectives. The presentation of an industry supported “Six Nation Public Opinion Survey of Cancer Knowledge and Attitudes” provided detailed insight into how the general public, patients and caregivers view cancer alongside various available and possible future therapies. An interactive ‘perspectives activity’ session provided all participants with an opportunity to think through and discuss the HTA process, and its challenges, from the four distinct positions involved. We declare that we have no conflicts of interest.