The future of cancer care

Health bud­gets are under increas­ing strain and can­cer inci­dence is increas­ing. NHS can­cer ser­vices have big con­straints to man­age, with­out the added stress of a nov­el virus.

But the UK can­cer com­mu­ni­ty remains opti­mistic. The future of non-sur­gi­cal can­cer care is excit­ing and will be defined by ear­ly dis­ease detec­tion, tech­no­log­i­cal advances, includ­ing  arti­fi­cial intel­li­gence (AI), and an increas­ing­ly per­son­alised approach to all aspects of care. This includes fol­low-up shaped direct­ly by patients through patient-report­ed out­come mea­sures.

Screen­ing will be tai­lored, even­tu­al­ly includ­ing indi­vid­u­alised genet­ic risk fac­tors, iden­ti­fied by “read­ing” our genet­ic code. Widened screen­ing, cou­pled with new path­ways to diag­no­sis, includ­ing ded­i­cat­ed “one-stop shop” com­mu­ni­ty diag­nos­tic hubs, have the very real poten­tial to boost patient out­comes and sur­vival by detect­ing more can­cers at an ear­li­er stage. Bet­ter, less dam­ag­ing treat­ment options exist for ear­ly-stage can­cer, so we will see a shift towards those treat­ments, improv­ing cure rates.

Personalising care to cancer patients

Peo­ple, and not just old­er peo­ple, have oth­er ill­ness­es which impact their can­cer ther­a­pies. Indi­vid­u­alised “pre­ha­bil­i­ta­tion” for patients will ensure the quick­est recov­ery, both men­tal and phys­i­cal. Sim­ple sign­post­ing to advice on nutri­tion, exer­cise and smok­ing ces­sa­tion will become a rou­tine part of the can­cer treat­ment pack­age. More inten­sive pre­ha­bil­i­ta­tion for patients with lung can­cer, for exam­ple, might include res­pi­ra­to­ry phys­io­ther­a­py and exer­cise class­es. 

Cur­rent­ly, clin­i­cians are able to seg­ment some patients based on the char­ac­ter­is­tics dis­played by their tumours. For exam­ple, there are now four dif­fer­ent rou­tine tests that enable clin­i­cians to rec­om­mend the best drugs to com­bat non-small cell lung can­cers. With advances in genomics, we antic­i­pate being able to tai­lor treat­ment to fit every person’s indi­vid­ual genet­ic make-up, giv­ing the best chance of can­cer con­trol to all patients.

We are already start­ing to see the ben­e­fits of research, lead­ing to short­er, less intense cours­es of treat­ment for cer­tain can­cers, most notably short­er radio­ther­a­py regimes for women with par­tic­u­lar breast can­cers. Many multi­na­tion­al tri­als have proven reduc­ing chemother­a­py and radio­ther­a­py in lym­phoma treat­ment doesn’t reduce cure rates. 

New technology aiding cancer care

UK can­cer teams are also pio­neer­ing new radio­ther­a­py tech­nol­o­gy that aims to make treat­ment even more pre­cise. Mag­net­ic res­o­nance lin­ear accel­er­a­tors, first tri­alled at The Christie and Roy­al Mars­den can­cer cen­tres, can map tumours and adapt treat­ment in real time. It is hoped they will improve tar­get­ing of tumours that are mobile or dif­fi­cult to see using stan­dard tech­niques.   

AI pro­grammes have huge poten­tial to aug­ment care, with uses rang­ing from help­ing clin­i­cians pro­vide tai­lored infor­ma­tion for patients, as well as pro­vid­ing back-up to clin­i­cal judg­ment in radio­ther­a­py plan­ning and the inter­pre­ta­tion of imag­ing tests.

The abil­i­ty to roll out these inno­va­tions rests on the resourc­ing, adapt­abil­i­ty and sta­mi­na of the mul­ti­dis­ci­pli­nary can­cer care team, com­prised of oncol­o­gists, nurs­es, radi­og­ra­phers, phar­ma­cists, physi­cists and many oth­ers, all work­ing togeth­er for the ben­e­fit of each patient.

To give the best care, health pro­fes­sion­als will need time to assim­i­late the newest treat­ment tech­nolo­gies. How­ev­er, hav­ing clin­i­cians work at the top of their licence to improve out­comes will be as exhaust­ing as it will be excit­ing.

The can­cer work­force needs to be sup­port­ed; hap­py doc­tors deliv­er safer care to more sat­is­fied patients.     

To safe­guard the future of can­cer care, there must be invest­ment in the future of our can­cer staff, which means grow­ing the can­cer work­force, bol­ster­ing clin­i­cal lead­er­ship and real­is­ing the vision of NHS England’s Peo­ple Plan in mak­ing the NHS the best place to work.