CONSULTING ROOM AT THE NEW OAK CANCER CENTRE SUTTON
In January 2022, the Lady Garden Foundation kindly funded a consultation room in the state-of-the-art Oak Cancer Centre in Sutton. This generous support will help give more patients access to The Royal Marsden’s life-saving treatment and care. The new centre will provide welcoming, purpose built environments, rooms that are full of natural light, and spaces equipped with the most modern technologies and facilities.
The Royal Marsden will be the first hospital in the UK that co-locates world-leading researchers in the same physical space as patients with the most challenging and rare types of cancers. The benefit of doing this will be that we will gain much greater patient insight, whilst greater visibility of our clinical research amongst patients, their friends and family, will increase the amount of patient-generated research ideas. The result will put patient care firmly at the heart of our research.
Over the past year, The Royal Marsden has seen the transformation of the Sutton site taking shape. Despite the challenges presented by the COVID-19 pandemic, construction work has continued at pace and the building has now reached its maximum height.
USING MACHINE LEARNING TO IMPROVE RADIOTHERAPY PLANNING FOR GYNAECOLOGICAL CANCER - LED BY DR ALEXANDRA TAYLOR
Machine Learning (ML) models have shown promising results for improving contouring accuracy for drawing around tumours although there is little experience to date of how to evaluate and integrate these methods into the radiotherapy planning process. This project is investigating how to develop and integrate ML models for use in treating cervical cancer. It aims to improve accuracy in radiotherapy and ultimately improve the overall quality of treatment for patients.
Dr Katherine MacKay, a clinical research fellow, is leading this project. She has developed the datasets used to train the ML model for auto-contouring cervical cancer images and produced a pilot clinical assessment tool which will enable structured evaluation of which auto-contours can be used.
Over the next year, the ML model auto-contouring results will be reviewed and then applied to a cohort of patient scans, to see if the results are reproducible. The contours produced by the auto-contouring model will also be compared to contours produced manually by at least five clinicians. The clinical assessment tool developed by the researchers will be used to evaluate the results..
TROPICCANA TRIAL: USING BLOOD SAMPLES TO MONITOR THE PERSISTENCE AND RECURRENCE OF CERVICAL CANCER FOLLOWING CHEMORADIATION TREATMENT - LEAD BY DR SUSAN LALONDRELLE
This trial will evaluate whether a simple blood test can be used to monitor how women with cervical cancer respond to chemoradiation treatment - which combines chemotherapy with radiation therapy - and also to detect relapse of the condition.
The clinical trial TROPICCANA (Treatment Response In Cervix Cancer Assessed by circulating HPV DNA) will test the hypothesis that if no circulating HPV DNA is detectable three months after treatment is completed, this will show that treatment has been successful. The researchers will also study if cHPV DNA is re-detected when the patient relapses.
There has been a slight delay to the project due to unforeseen, reduced capacity in the clinical unit. The protocol and associated trial documents have now been finalised and patient recruitment for the trial will begin next year.
ENDOMETRIAL CANCER PROFILING PROGRAMME AT THE ROYAL MARSDEN - LED BY DR ALEXANDRA GEORGE
This project is testing the molecular make-up of all cases of endometrial cancer at The Royal Marsden over a one year period, along with 100 retrospective cases, to predict the behaviour of an individual’s tumour, which can help determine how best to treat the disease. This is important as the diagnosis and classification of endometrial cancer is complex. The disease is highly variable, while some cases have a good prognosis, in others the cancer behaves aggressively and worsens.
Dr George’s team is examining the impact of this testing on patient outcomes with the aim to potentially direct treatment accordingly. A key focus is on identifying patients who would benefit from immunotherapy, rather than chemotherapy, to ensure the best possible outcome.
Recruitment of patients began in June 2021 and ended in May 2022. Dr George’s team has now completed all of the testing for newly diagnosed patients and are awaiting the final batch of results from those who have relapsed.
To date, the testing has identified a number of individuals who will not require additional treatment (such as radiotherapy) thanks to identifying POLE mutations in their tumour, which hugely reduce the chance of cancer recurrence. The team has also identified a number of individuals with high-risk disease, who would not have been predicted by their other tumour factors, who require additional treatment to cure the disease.
The provisional data has formed part of a submission to NHS England and this has resulted in POLE testing being added to the National Genomic Test Directory earlier this month. This genetic testing is delivered at the Genomic Hub Laboratory that The Royal Marsden is part of (The North Thames Genomic Laboratory Hub).
Any clinician in the UK can now send samples to RMH for testing, but uptake is not expected to be widespread until testing is able to be offered by the other six Genomic Hub Laboratories, which are yet to develop and validate this. The goal is to make this type of genetic testing available on the NHS for all endometrial cancer patients in the future, making a significant difference to those with a diagnosis of endometrial cancer.
The research team has also identified a number of potentially targetable mutations in patients and, ifthe mutations are common in those with relapsed disease, this could lead to the development of new clinical trials for these patients. This has the potential to further expand treatment options for patients with endometrial cancer.
SCALP COOLER MACHINE
The impact of chemotherapy treatment on many cancer patients can result in the loss of hair from the scalp and body, including eyebrows and eyelashes.
Scalp coolers are tightly fitting, helmet-like hats filled with a cold gel or liquid that can be worn before, during and after chemotherapy sessions. They workby narrowing the blood vessels beneath the skin of the scalp, which reduces the amount of chemotherapy medicine that reaches the hair follicles. Sensors inside the cap ensure the scalp is kept at a constant temperature. By cooling the scalp in this way, hair loss is reduced which can significantly improve patients’ self-esteem.
We funded three double scalp coolers, thereby providing six caps for use by cancer patients. The scalp coolers are popular with patients and each cap is used between 3-5 times per day.
Feedback provided shows that patients value using the coolers which have helped them to better cope emotionally with their cancer treatment, easing any further distress.
A patient who used a scalp cooling cap during her treatment said: “Being able to keep my hair during chemo kept me feeling whole during a time I felt I had no control.”
ULTRASOUND MACHINE
Ultrasound is a non-invasive imaging method that, when performed by an experienced diagnostician, can play a valuable role in the primary diagnosis of gynaecological cancers. It can also help detect recurrent and/or metastatic disease and diagnose and guide treatment of postoperative complications.
The MIS Samsung RS85 Prestige model, a new state-of-the art ultrasound machine, has arrived at the hospital and was used for the first time, in the new ultrasound room at our Chelsea site on 5th December 2022.
The premium ultrasound system generates uniform, high-resolution images and has intelligent software features that fine tune image quality in specific situations, providing measurements, assessments of blood flow, and other useful metrics to provide a fast and accurate diagnosis for patients.
SEEKING GENOMIC INSIGHTS INTO RADIOTHERAPY-RESISTANT GYNAECOLOGICAL SQUAMOUS CELL CANCERS - LED BY DRS BEN O’LEARY & SUSAN LALONDRELLE
This pilot study aims to explore whether cervical, vaginal and vulval cancers which recur after radiotherapy, have specific changes in DNA that could be used to identify patients at a higher risk of relapse, or provide insights into why particular cancers cannot be cured by radiotherapy. Researchers will collect and analyse DNA samples from patients with gynaecological cancers taken at the time of salvage surgery - surgical treatment for local residual/recurrent lesions after definitive, non-surgical treatment - and following radiotherapy treatment. Initial preparatory work is focusing on human papillomavirus (HPV+) cancer cells, as HPV features in many gynaecological cancers.
The research team recently conducted a pre-study pilot experiment on HPV+ cancer cells to explore exactly how the HPV genome integrates into the cancer DNA and what this might mean for treatment. The results have been very encouraging and early analysis indicates that it will enable the researchers to detect the exact points at which the HPV virus enters the host genome. The next step will be to test this on a small number of clinical samples.
FAT TISSUE GRAFTING TO TREAT SYMPTOMS OF VAGINAL STENOSIS IN WOMEN WITH GYNAECOLOGICAL CNACER - LED BY MS MARIELLE NOBBENHUIS
Cervical cancer and its associated treatments, especially radiotherapy, can cause several changes in the vagina such as narrowing, shortening, dryness and bleeding, known as vaginal stenosis. Consequently, women can experience significant pain during sex, loss of sexual pleasure and some women become unable to have sex. This can, in turn, cause sexual avoidance, relationship problems, feelings of low self-esteem, isolation and difficulties initiating new relationships.
Last year, a new surgical technique called ‘Fat Tissue Grafting’ was used on a patient with severe vaginal stenosis following radiotherapy treatment for advanced cervical cancer at The Royal Marsden. The technique uses fat tissue that is removed from other parts of the body - usually the thighs, belly, and buttocks - by liposuction, which is then prepared and injected into the vagina area to generate more elasticity and improve the quality of the vaginal tissue. Following the procedure, this patient experienced a reduction in vaginal bleeding and pain, and a noticeable improvement in the size of the vagina, allowing for penetrative sex.
This feasibility study will examine the surgical experience and outcome for women who have undergone the fat tissue grafting procedure. Set-up of the study is underway and the research team is meeting regularly. Patient recruitment is expected to begin in April 2023.
ASSESSING THE REASONS FOR PARP INHIBITOR RESISTANCE IN SOME WOMEN WITH OVARIAN CANCER BY PROFESSOR SUSANNA BANERJEE
PARP inhibitors, such as the drug Niraparib, have transformed the care of women worldwide with newly- diagnosed and recurrent ovarian cancer, helping to increase remission rates, however, they do not work for all women with ovarian cancer and for some, resistance can develop, causing the cancer to worsen or return.
Circulating tumour DNA sequencing, known as ‘liquid biopsies’- simple blood tests that can be used to help find cancer - provide a convenient and non-invasive way to assess and monitor the development of PARP inhibitor resistance in patients.
This trial, led by Dr Banerjee, is collecting blood and tumour samples from women with newly diagnosed, or relapsed ovarian cancer, who are being treated with Niraparib and who are enrolled in The Royal Marsden sponsored Monitor-UK study. It is using a targeted sequencing gene panel developed by the Institute of Cancer Research and The Royal Marsden to detect mutations or changes in specific genes known to be implicated in the development of PARP inhibitor resistance. Dr Banerjee’s team has received ethical approval for this trial and began collecting samples from patients in November 2022.
PSYCHOSEXUAL THERAPIST PROVIDES VITAL SUPPORT FOR THE ROYAL MARDEN PATIENTS
Caroline Lovett, a psychosexual therapist at The Royal Marsden, works with women with gynaecological cancers who often undergo gruelling treatments. She provides them with valuable psychological support to help them to process what they have been through, as well as practical solutions to promote their sexual wellbeing, post-treatment. The Lady Garden Foundation is generously funding her post for this current financial year.
The experience of having gynaecological cancer and undergoing treatment can alter how women view themselves sexually and psychologically, supporting these women is vital to help them deal with the impact of having this cancer on their lives. For example, for some women may not be able to feel sexual pleasure in the same way they had previously. Caroline helps women to be creative and discover new ways that they can experience pleasure by exploring the whole self as a sexual being.
Caroline also supports patients in their physical rehabilitation after treatment. Women who receive radiotherapy are often given vaginal dilators to use to open or stretch vaginal tissue so that it is comfortable for them to have penetrative sex. For women who find the dilators uncomfortable, Caroline has introduced new approaches, such as the use of lubricants to help ensure women are using the dilators and benefiting from the treatment.
Caroline sees women either on a one-to-one basis, or with their partners. Most have around ten sessions, but this can vary depending on what they are working through. Patients can self-refer to Caroline but they often come through the clinical nurse specialists or their consultants.
One patient who attended sessions with Caroline said “You have helped me find that part of myself that I thought the cancer had stolen”.
As part of her role, Caroline is establishing a menopause support group at the hospital along with her colleagues in the psychological support team. The group is intended for women who have gone through the menopause as a result of their treatment, and the first meeting will be held in January 2023. Caroline and the team hope that women attending this group can help each other by sharing their experiences.
Octopus Trial
The Lady Garden Foundation kindly agreed to support some of the translational research within phase II of the OCTOPUS trial, a national study. Phase II of the trial involved 140 patients with relapsed ovarian cancer.
They were either given chemotherapy with the targeted therapy drug Vistusertib or chemotherapy with a placebo. This phase of the trial was the first of its kind to test whether this type of targeted therapy used alongside chemotherapy could improve outcomes for women with ovarian cancer. Dr Banerjee presented the phase II trial findings at the European Society for Medical Oncology conference in Barcelona in September 2019.
The results found that the treatment which combined chemotherapy and the targeted therapy drug Vistusertib was not superior to chemotherapy as a treatment on its own. However, the translational work which was part funded by the LGF, identified that patients with a certain molecular profile may benefit from the combination of targeted therapy and chemotherapy more than others and this is being analysed further as part of a collaboration between The Royal Marsden, the Institute of Cancer Research and Imperial College. Translational research from phase II of the Octopus trial is helping shape future studies by developing an understanding around which patients respond better to targeted therapy drugs.
FUNDING OF A LAPAROSCOPIC VIDEO SYSTEM
We have funded a Laparoscopic Video Camera System which will be used at the Royal Marsden's Chelsea Hospital, to support surgeons carrying out gynaecological procedures. This peice of vital kit, which will help to provide a faster, more accurate diagnosis and plan treatment for patients with gynaecological cancers.
Laparoscopic surgery is used at The Royal Marsden to diagnose and treat several cancer types. 40% of laparoscopic procedures performed at The Royal Marsden in 2019/20 were on patients with gynaecological cancers. The laparoscopic video camera stack is therefore a vital piece of equipment for surgeons and the patients they treat.
COLPOSCOPE AND CAMERA SYSTEM
A colposcope is a specialist microscope with a light which is used to examine the cervix, vulval or vagina for abnormalities which may indicate the presence of cancer. The camera system allows high-resolution images of the area under investigation to be viewed on a screen by clinicians during a procedure. The colposcope and camera system is an incredibly important piece of equipment which enables the early diagnosis of gynaecological cancers and helps clinicians plan treatment throughout a patient’s gynaecological cancer journey.
The new colposcope and camera system arrived at our Chelsea hospital in May 2021 and the team are thrilled with the new equipment. It has enhanced image capture technology, allowing clinicians to spot even the smallest of abnormalities during procedures. It also has improved reporting capabilities which will enable clinicians to make even more accurate diagnoses.
INTEGRATION OF GENOMIC DATA INTO ENDOMETRIAL CANCER - LED BY DR ANGELA GEORGE
The diagnosis and classification of endometrial cancer is as complex as the disease is highly variable, with some cases having a good prognosis, and others where the cancer behaves aggressively. Recent advances have shown that molecular analysis can predict the behaviour of an individual’s tumour, which can help determine how best to treat the disease. Over a one-year period, this project is testing the molecular make-up of all cases of endometrial cancer at The Royal Marsden, along with 100 retrospective cases. This includes testing for mutations in the POLE gene – which is not currently available through the NHS in England – as well as testing for other potential disease mutations. Endometrial cancer patients with mutations in the POLE gene are less likely to experience recurrence, so could benefit from less aggressive treatment.
This work is enabling Dr George’s team to formally examine the impact of this testing on patient outcomes, and potentially direct treatment accordingly. There is a particular emphasis on identifying patients who would benefit from immunotherapy, rather than chemotherapy, to ensure the best possible outcome.
Recruitment of patients began in June and Dr George has received 165 results to date. So far, she has identified patients who are less likely to experience recurrence because of the molecular makeup of their tumour. This means that these patients can have less intense treatment for a shorter length of time. She has also identified patients who are now eligible for clinical trials, based on their results and disease status. In addition, Dr George’s team have identified several patients with possible inherited gene alterations, that would not have been tested for outside of this trial. These patients can now take measures to prevent other cancers that may be caused by these gene alterations. They also have an opportunity to inform family members, so that they can take steps to reduce their risk of developing cancer in the future.
Recruitment for this project will continue until the end of May 2022, with all gene sequencing to be complete by July of that year. The final analysis of clinical and genomic data will be completed by the end of August 2022 and we look forward to sharing this with you. Dr George then hopes to submit an application to NHS England, with the goal of adding full molecular classification testing for endometrial cancer to the National Genomic Test Directory. If Dr George’s application is successful, this would make this type of genetic testing available on the NHS for all endometrial cancer patients in the future; making a significant difference to those with a diagnosis of endometrial cancer.
USING AI TO IMPROVE RADIOTHERAPY FOR CERVICAL CANCER PATIENTS - LED BY ALEXANDRA TAYLOR
Accurately identifying tumours on radiotherapy planning scans is essential for successful treatment. However, clinicians often have to manually draw around the tumour and normal tissue on radiotherapy planning scans, which can be time-consuming. There can also be variation between doctor’s opinions on where exactly to treat. Machine Learning (ML) is a form of Artificial Intelligence that creates computer algorithms to emulate human performance. This project aims to develop an ML model to automatically plan radiotherapy scans for cervical cancer patients and investigate new approaches to account for the variation that occurs between individual clinicians and imaging systems. The aim of this work is to improve the treatment’s quality and patient outcomes, as well as build confidence in radiotherapy accuracy.
Dr Taylor’s team carried out preparatory work using scans from patients who had been previously treated for cervical cancer at The Royal Marsden. The scans were uploaded onto the Artificial Intelligence system and the information was integrated into the radiotherapy planning system. This formed the pilot model which is being used for the project.
Dr Taylor appointed clinical research fellow Dr Katherine MacKay, using generous funding from the Lady Garden Foundation, who started work on the project in October 2021. She is analysing the performance of the pilot model and plans to use another 100 CT scans to develop the algorithms used in ML to emulate human performance. Work on this project will continue until September 2023.
Artificial Intelligence, particularly with Machine Learning approaches, is going to significantly change how radiotherapy treatments are planned and delivered in the UK. Lady Garden Foundation funding is helping The Royal Marsden utilise these new techniques to improve radiotherapy treatments for gynaecological cancer patients everywhere.
PREDICTING TREATMENT BENEFIT IN LOW-GRADE SEROUS OVARIAN - PROFESSOR BANAJEE
Professor Banerjee is trying to establish whether mutations in a gene named KRAS can be detected in the blood of patients with LGSOC. The project will also look at whether the presence of KRAS gene mutations changes over the course of treatment and if this might indicate a clinical response to treatment. This will help guide further trials on treating and monitoring LGSOC patients.
Work on this project began in June and Professor Banerjee’s team, which includes clinical fellow Dr Lima and lead research nurse Sally Gill, have identified patients receiving active care for LGSOC at The Royal Marsden. The team also identified 40 LGSOC patients who had participated in previous research trials and had consented for their samples to be used in future work.
In December, the gene panel analysis of tumour samples began to test for specific mutations, including the KRAS mutation, at the Centre for Molecular Pathology on our Sutton site. In March 2022, the analysis of blood samples will commence to try and detect KRAS mutations. If KRAS mutations can be detected, they will be monitored over the course of a patient’s treatment to detect whether the presence of the mutations changes, depending on the treatment given.
The final report from this study will be produced by the end of 2023 and Professor Banerjee will submit the results for presentation at the National Cancer Research Institute. This project is a valuable opportunity to generate evidence that Professor Banerjee hopes will contribute towards an application for NHS-funded gene testing for LGSOC patients and the possibility of a new treatment option for these patients.
A BLOOD TEST TO DETECT CERVICAL CANCER RELAPSE-LED BY SUSAN LALONDRELLE
Researchers at The Royal Marsden and the Institute of Cancer Research, London, have developed a blood test that can detect the presence of human papillomavirus (HPV) – which causes 95% of cervical cancer cases – in the blood. They believe, following a small study of 22 women treated for cervical cancer, that if HPV is present in the blood at the end of treatment or detected during follow-up appointments, this can indicate cancer remaining or returning. Taking the data from this small study, Dr Lalondrelle will use the Lady Garden Foundation funding to expand the study to more patients. This will help her gather more evidence that could lead to the test being used in standard clinical practice.
Dr Lalondrelle’s team have identified project collaborators from institutions in the UK and study sites are being set up. Patient recruitment will begin in the New Year with the aim of recruiting 113 patients across UK sites.
The results from this study could prove that a blood test for HPV-DNA is as good, or better than current methods used to detect relapse in cervical cancer patients. A blood test could replace some or all of the hospital-based follow-up currently undertaken and could lead to earlier detection of relapse, when more treatment options may be available.
RESEARCH INTO THE IMPACT OF COVID-19 ON CANCER TREATMENT AND CARE
During the first wave of the COVID-19 pandemic, researchers at The Royal Marsden launched several studies to investigate the impact of COVID-19 on cancer treatment and care.
CAPTURE study lead, Dr Samra Turajlic Funds from the emergency appeal, including donations from long-term supporters of the Charity, The Lady Garden Foundation and The Henry Oldfield Trust, made this research possible.
Professor David Cunningham, Consultant Medical Oncologist and Director of the NIHR Biomedical Research Centre said: “We are uniquely placed to look at COVID-19 in a cancer setting.
Our teams worked at pace to establish studies with a focus on immediate impact through to a longer-term understanding of this novel virus. Thanks to funding from The Royal Marsden Cancer Charity and the NIHR BRC, we hope this research will have a national and international impact.”
Hundreds of patients have been recruited to six studies and thousands of samples have been analysed.
The CAPTURE study, led by Dr Samra Turajlic, aims to understand the biology and interactions between COVID-19, immunity, cancer and cancer treatment among patients and hospital staff.
Preliminary data, presented at the American Association of Cancer Research conference in April 2020, has shown that a wide range of antibody levels and COVID-19-specific T-cells were detected, but the potential impact of cancer type on their immune response must be considered for further analysis.
The OCTAPUS-AI study, led by Dr Richard Lee, is analysing over 900 cancer patient scans using artificial intelligence. The aim is to provide clinicians with information on whether changes in the lung are due to COVID-19, another infection or a side effect of treatment.
An additional part of this study will be to diagnose subtle changes in lung cancer recurrence earlier so that it might be treated earlier and more effectively.
THE IMPACT OF COVID-19 IN ONCOLOGY - BURNOUT AND WELL-BEING LED BY PROFESSOR SUSANNA BANERJEE
Professor Banerjee’s national study, which is funded by LGF, is exploring the effect of COVID-19 on the mental health of clinicians working with cancer patients. Working alongside researchers at Lancaster University, she hopes the findings will help to develop well-being initiatives and shape supportive policies throughout the NHS during COVID-19 and beyond.
The study was launched in June 2020 and a survey was sent to frontline NHS staff members who work with cancer patients across the country to measure burnout, resilience and well-being. Over 1,038 doctors, nurses, pharmacists, administrators and allied health professionals such as dieticians and physiotherapists working in oncology took part in the survey.
The results, which were selected to be presented by Professor Banerjee at the virtual National Cancer Research Institute Showcase in November 2020, found that whilst 66% of staff felt able to do their job without compromising their personal safety, 42% of staff felt they were likely to be ‘at risk’ of poor wellbeing and 34% indicated signs of burnout. The survey also uncovered the coping strategies staff use, with doctors tending to use planning and humour as strategies, whereas allied health professionals sought out emotional support and information from others. Staff were also asked how valued they felt by their organisation and by the public. Overall, 68% said they felt valued by the public and 66% said they felt valued in the workplace. These results are due to be published in Spring 2021.
Professor Banerjee hopes that the information collated in this study will inform new supportive policies in the NHS, to help staff overcome new challenges in the future and prevent burnout. For example, knowing that many staff felt at risk of poor wellbeing during the pandemic could influence when interventions are taken to protect staff. Understanding what type of initiatives different staff groups found helpful, could lead to the development of initiatives tailored to specific groups.
ATARI STUDY
Part of The Lady Garden Foundation’s funding has been protected to continue our involvement with the ATARI study once the main trial is completed. The trial will include 20-30 hospitals across the UK, France and Canada and involve up to 116 patients. It could revolutionise treatment options for women with rare, relapsed or advanced cancer.
Currently, only 1 in 10 will see tumour shrinkage with chemotherapy but early results suggest that 1 in 6 women may have a greater chance of responding to ATR inhibitors. Lady Garden Foundation funding will support work to understand why some patients respond to the drug and some do not, therefore finding out what clinicians need to test for to see if this is the best treatment option for a patient. Without Lady Garden Foundation funding the trial would not be possible,
OBTAINING CONSENT AND SAMPLES
Research fellows funded by LGF have supported a project collecting blood and tissue samples from patients diagnosed with gynaecological cancers to be used in current and future research projects. Patient samples are a precious commodity in cancer research. Without them, it would simply not be possible to carry out meaningful research into the causes and consequences of cancer, or to develop and test new therapies.
Dr Julian Wampfler joined the project team in 2019 and since our last report, the team have focused on increasing the number of tissue and blood samples collected. Dr Wampfler has helped obtain consent from a further 50 patients as well as collecting an additional 450 tissue and blood samples. The team are delighted to have obtained this number of samples as the collecting, processing and preserving of samples is a technical and time-consuming process. Since the project started in 2016, a total of 750 patient consents and 650 samples have been obtained. The samples that have been collected are being carefully stored, to be used when required on current and future research projects undertaken by the gynaecology unit at The Royal Marsden.
BRCA TESTING
LGF funding helped support a pilot study which was undertaken to refine the BRCA gene test, to provide accurate and efficient results that could guide patient treatment. The BRCA gene test identifies whether patients carry BRCA 1 or BRCA 2 gene mutations. The gene test result helps patients to get the best management for their cancer. Evidence shows that patients with these genes may benefit from targeted therapies like Olaparib, the PARP inhibitor used in the ATARI study.
This successful pilot study has helped to develop how BRCA tests are carried out on women diagnosed with ovarian cancer and since our last report, The Royal Marsden team worked with AstraZeneca to implement this test as part of routine practice in NHS Trusts across the UK. Tumour samples are taken from patients at their local hospitals and they are sent to be analysed in one of five laboratories across the country which include The Royal Marsden’s Centre for Molecular Pathology in Sutton as well as sites in Bristol, Manchester, Aberdeen and Glasgow. The testing is ideally carried out shortly after diagnosis and the results, which help guide treatment plans, are returned within 4 weeks. This method is more effective at identifying the BRCA gene in women with ovarian cancer because it identifies both types of mutations, those that are inherited and those that are not, from within the tumour itself. This method can identify 50% more women with the BRCA mutation within their cancer than through a blood test alone. This means that more patients are being identified that could benefit from PARP inhibitors and other drugs that target BRCA mutations.
Impact Update!
We are delighted to announce we have funded a Lady Garden Pre-Doctoral Fellowship. The Pre-Doctoral Fellowship programme at The Royal Marsden provides funding for nurses, allied health professionals, or pharmacists looking to begin their academic career.
The Lady Garden Foundation Fellowship will be undertaken by Andreia Fernandes, Lead Nurse for Gynae-oncology at The Royal Marsden since 2019. She has over 19 years of clinical and research experience in gynae-oncology across a variety of roles. She is passionate about improving outcomes and experiences for women with gynaecological cancer and is based within an active gynaecology research group.
Andreia has authored and co-authored several publications, including journal articles and book chapters. Her ambition is to be a consultant nurse and a leading academic researcher in gynaecological cancers.
Funding Update!
Our newly formed Lady Garden Scientific Committee, led by Professor James Larkin at The Royal Marsden, alongside our Chair Jenny, one of our Trustees Dr Annalisa Jenkins MBBS FRCP, and other medical experts, met to review various grant applications. Of those submitted, we have chosen four projects to receive Lady Garden Foundation funding and they are as follows:
1. Using Circulating HPV-DNA (cHPV-DNA) to assess response and monitor for relapse after chemoradiotherapy for cervix cancer- led by Dr Susan Lalondrelle
2. Incorporating advanced machine learning methodologies into radiotherapy planning for gynaecological cancer- led by Dr Alexandra Taylor
3. Predicting treatment benefit in low grade serous ovarian cancer (LGSOC)- tumour and liquid biopsy mutation analysis- led by Dr Susana Banerjee
4. and Integration of genomic data into endometrial cancer reporting at the Royal Marsden led by Dr Angela George
We are honoured to be able to fund projects of this magnitude thanks to you all and already cannot wait to see the results and the difference this research will make on the gynaecological cancer landscape. In addition to the above we have also recently purchased a Colposcope and Camera System’ which will specifically be used for the early diagnosis of, and to plan treatment for, gynaecological cancers, at The Royal Marsden Hospital.
SURVEY REVEALS 86% OF WOMEN ARE UNAWARE OF GYNAECOLOGICAL CANCER SYMPTOMS & 58% ARE EMBARRASSED OR UNAWARE OF THE IMPORTANCE OF HAVING AN OPEN DIALOGUE
The pandemic has led to a significant disruption in cancer services across the NHS with activities across the whole cancer pathway being affected*. Cancer Research UK has reported that around 2.5 million cancer tests or treatments have been missed because of Covid-19 and The Institute for Public Policy Research reported a 43 percent drop between April to June this year (339,242 people in total) in urgent two-week wait referrals from GPs for diagnostic tests compared to 2019 (594,060 people).
Dr John Butler, Medical Director of The Lady Garden Foundation and Consultant Gynaecologist at The Royal Marsden Hospital comments: “Now the UK is well past the peak of the coronavirus epidemic the NHS is very much open for business and it’s vital that people attend their cancer screening tests and see their doctor if they have any new or persistent symptoms they are concerned about. There is a major concern that a fall out from the priority that has been given by the health service and government to managing coronavirus, will cause delayed cancer diagnosis and treatment. Furthermore the charity sector is seeing a major reduction in fundraising which is limiting lifesaving research.”
The nation needs to re-engage with the NHS as smear testing services resume across the UK and GP’s surgeries are open. Some symptoms of gynaecological cancers can be more subtle, and often misattributed and it is vital that women visit their doctor with any concerns.
Based on a survey carried out by the Foundation in July 2020, across 100 women from the ages of 18 to 44+, a staggering 78% of women were unaware of the five different gynaecological cancers and 86% of them did not know what symptoms to look out for. - The five gynaecological cancers, Ovarian, Cervical, Uterine, Vulval and Vaginal, are often referred to as Silent Killers, not only because of their complicated symptoms which can be missed by healthcare professionals, but also due to a lack of awareness surrounding these diseases. By the time a diagnosis is made, the cancer can be advanced and therefore, the chances of survival are far lower, with an average mortality rate of 44%. *
19 symptoms were shared with the surveyed women of which 44% were oblivious to them being possible indications of gynaecological cancers. 78% were unaware that a loss of appetite was a symptom, and on average 62% did not know that: constipation, feeling bloated, the need to pass urine more often, weight gain/loss or unexplained extreme tiredness could also all be manifestations of gynaecological cancers.
There is no single screening test available for all five gynaecological cancers which is why knowing what to look out for is so important. Raising awareness of these symptoms could lead to earlier diagnoses and essentially save lives. Smear tests can identify HPV or Human papillomavirus - this is the name for a very common group of viruses. Some types of HPV in the cervix can cause abnormal changes in the cells that can sometimes turn into cervical cancer. Our survey showed that due to Covid-19 around 25% of women were unable to progress with their annual smear test as clinics cancelled appointments and/or women felt uncomfortable visiting GPs. Raising awareness and removing the taboo on the subject of women’s sexual health is so important especially as many have not felt comfortable reaching out to their doctors alongside the pause in smear testing during the global pandemic.
The survey highlighted that 58% of the participants were either embarrassed or unaware of the importance of having an open dialogue with friends and family on gynaecological health, however 98% said that they would speak up more if they knew it could save lives.
Talking about and understanding the symptoms of the cancers will save lives. Help us by joining the conversation - it's time to ensure these cancers are #SilentNoMore.
*Cancer Research UK statistics- 2015-2017*The Institute for Public Policy Research
“The impact of COVID-19 in oncology – burnout and wellbeing”, a research project funded by The Lady Garden Foundation
Many of you will know of the amazing Dr Susana Banerjee. She has a long-standing relationship with The Lady Garden Foundation as we have funded some of her research into gynaecological cancer at The Royal Marsden Cancer Charity. Dr Banerjee is now leading a critical research study, calling on NHS staff to answer surveys about their wellbeing during the COVID-19 crisis.
The Royal Marsden want to establish a better understanding of how the COVID-19 pandemic has impacted on the wellbeing, resilience and burnout of NHS staff working in a cancer healthcare setting. Working alongside psychologists from Lancaster University, they will be launching a national study that invites all NHS staff looking after cancer patients to complete 3 surveys that will be released over the next year. Questions will assess burnout, resilience, well-being and coping strategies amongst staff, not just during the immediate COVID-19 pandemic period, but also in the long term.
Dr Banerjee says of the study “Those working in oncology face unique challenges during the COVID-19 pandemic, which researchers fear could cause anxiety and stress amongst the workforce. Cancer patients are particularly vulnerable, with often complex treatment plans in place. Clinicians are making critical and difficult decisions daily, balancing the need to continue care, with the risks COVID-19 presents for cancer patients. We need to support all staff – not only those on the frontline– so that they remain well and committed to their work in the NHS to keep delivering world class care to our cancer patients. Wellbeing, resilience and reducing ‘burnout’ is fundamental to this.”
Managing Director of The Royal Marsden Cancer Charity, Antonia Dalmahoy, said: “Funding ground-breaking research is a fundamental part of our support for The Royal Marsden, and means clinical teams can continue to provide the very best care and life saving treatments for cancer patients across the UK. It’s thanks to our generous supporters like The Lady Garden Foundation that we’re able to keep looking for ways to improve the lives of people affected by cancer, even during the most challenging of times.”
Royal Marsden Cancer Charity ‘Fighting Fund’
The Lady Garden Foundation has a long-standing relationship with The Royal Marsden Cancer Charity and since we were founded in 2014 we have donated over £1m to fund ground-breaking research and cutting-edge studies in order to determine more personalised treatment for patients with gynaecological cancers.
Unfortunately cancer doesn’t stop because of a lockdown and the impact of COVID-19 is unprecedented and wide- reaching. As the Royal Marsden’s needs are changing daily, The Royal Marsden Cancer Charity has created a “Fighting Fund” to support staff and patients. Royal Marsden staff are working tirelessly in very challenging circumstances, and this fund will provide support for them as they continue to provide the very best patient care.
The Lady Garden Foundation has made a donation of £40,000 to this Fighting Fund in order to help support frontline staff as well as enabling remote patient consultations to prevent patients from leaving their homes unnecessarily. The Fighting Fund will ensure the hospital has the flexibility to respond to the crisis and be able to place the funding where it will provide the most benefit to patients and staff. It is thanks to all of our loyal supporters that we have been able to make this donation and we cannot thank you enough .