July 2008 transcript
00:00
Kat: Welcome to the Cancer Research UK podcast, with me, Dr Kat Arney. In this month's podcast we find out how researchers in Edinburgh are looking for new ways to relieve pain for people with cancer, to improve their quality of life.
Coming up later, we'll be finding out how a new initiative is aiming to bring together crack teams of scientists to solve some of the most challenging problems in cancer. But first, here's the news with Jo Peak.
01:03
Jo: Scientists at the Institute of Cancer Research are running a large-scale clinical trial for men with prostate cancer. Led by Dr Chris Parker, the Cancer Research UK-funded trial is recruiting around 4,000 men from the UK and internationally.
Here's Dr Parker to explain more about the trial.
"The RADICALS trial attempts to define the best treatment for men who have had an operation to remove their prostate for prostate cancer. So the standard approach is a radical prostatectomy – that's an operation to remove the whole prostate. What we don't know is whether these men should have additional treatment.
So if for example you take women with breast cancer, if they have surgery to remove the cancer, they routinely have radiotherapy and hormone therapy, and sometimes other treatments too. But in the case of prostate cancer we don't know if there's any value in giving additional treatment like radiotherapy or hormone therapy after surgery.
I would like all men who are due to have an operation to remove their prostate for prostate cancer to be aware of the RADICALS trial. It's open in around fifty centres throughout the UK, so no matter where a man is having his surgery, he could enter the RADICALS trial, should he wish to do so."
Cancer Research UK is funding a new national clinical trial called POET, finding out whether a contraceptive coil called Mirena can prevent womb cancer in women with an inherited predisposition to the disease. Lynch syndrome is due to an inherited fault in the HNPCC gene, and women with the condition have a 60% chance of developing womb cancer – much higher than the 2% risk in the general population.
Here's Professor Shirley Hodgson, who's leading the study, talking about her hopes for the trial and the importance of her work.
"I think it's going to be a very helpful option for women with Lynch syndrome, because they may well feel they're frightened of the risks of endometrial cancer but that they don't want to have their uterus removed, perhaps if they're fairly young and they want to consider having babies maybe later. So it may be a very good option, say, to have the Mirena for five years, then say "I'll have my babies after that". They may be more comfortable with not having the surgery as well.
This is very much on the agenda of Cancer Research UK, to reduce the risks of cancer developing – and in Lynch syndrome the risks are pretty high. I think it is a really important way of trying to reduce these risks."
And finally, a study published in the British Journal of Cancer has shown that the UK is punching above its weight when in comes to cancer research. The authors looked at all the research that feeds into 43 of the clinical guidelines that doctors use to treat cancer patients, and found that research papers from the UK are cited three times more often than might be expected.And the study also revealed that Cancer Research UK supported over one third of the clinical trials that were used as evidence for treatment guidelines. This highlights the impact of the work that's funded by the charity, and demonstrates the importance of our life-saving research.
Kat: And if you want find out more about these stories, or get the latest from the charity's scientists, and researchers around the world, then have a look at our News & Resources website.
04:51
Kat: Cancer Research UK is assembling crack teams of scientists drawn from the UK and around the world to tackle some of the most challenging problems in cancer science.
To find out more about the background to the initiative, I spoke to Simon Youlton from < href="http://www.cancertechnology.com/" target="_blank">Cancer Research Technology, the charity's wholly owned technology transfer company.
"It was about three years ago the first ideas came about from a management team session and I was appointed to look into one of these ideas, and it escalated from there. My role has been very much to co-ordinate a team to see if we could project this idea and from there on in choose the science and the business model we've now elected to use – that's to bind five individual researchers from different institutes, initially around the UK – each tasked with a particular problem that we posed them. We bind them together in the form of a limited company for a two-year grant"
So far, the charity have identified three key areas of science in which to set up these consortia. The first group, looking at the issue of cell senescence, is led by Professor Nicol Keith from the Beatson Institute for Cancer Research in Glasgow. I asked him to explain more about this phenomenon, and how it's linked to cancer.
"We've known about cell senescence for a number of years and this is something that in normal cells gives a limit to the number of times a cell divides, so it's a brake on cell growth. That's a very good thing to have in normal cells, and this point at which cells stop growing is called cell senescence. There are a number of ways this can happen – one is when the cells get too old, for example, and they stop growing.
One of the major hallmarks of cancer is that [the cells] bypass the senescence barrier. So senescence is a very powerful tumour suppression mechanism, stopping you from getting cancer. When cancers break through this barrier, it’s bad news for the cells. So cell senescence is this block which is overcome during the cancer process so the cells become immortal."
But what's so new about this way of working? I asked Keith Blundy, Chief Executive of Cancer Research Technology to explain.
"The idea here is that rather than allowing research teams to evolve organically, by their own impetus, we've picked specialist crack teams who have particular functional capabilities, who we think, by our own peer review and assessment at Cancer Research Technology working on behalf of Cancer Research UK, will form a great new team to solve these problems. We've brought them together with Cancer Research UK funding into a new programme.
It's important to stress that although Cancer Research UK works with the pharmaceutical industry, we are an independent charity. Simon Youlton again.
"None of this Cancer Research UK goes directly to the pharmaceutical industry – so we're not funding the pharmaceutical industry at all. But we need the pharmaceutical industry. We're not funding them, but they also are funding our programmes. I am very optimistic that once we present to them the details of our collaborative initiatives – this first one and the subsequent two – they will also contribute hard cash.
We're funding this programme to the tune of half a million pounds. I'm looking for a pharmaceutical partner who's also prepared to finance up to half a million themselves to accelerate the programme so we can do even better, faster."
Finally, what does this mean for people with cancer?
It means that we take the brightest looking stars and the best looking discoveries from our cancer research base and take those faster to the clinic than we’ve ever been able to do before. It means that once we identify them we bolster them with additional experts from around the world to give them the best opportunity of getting to the clinic. It's a hard task to get anything to the clinic, so it needs every opportunity it can get.
09:00
Kat: Managing pain is a crucial part of any treatment for people living with cancer. Two of the major challenges are neuropathic pain, that's pain caused by nerves, and bone pain – both of which can be difficult to manage with the drugs we currently have available.
Marie Fallon, Professor of Palliative Medicine at the Edinburgh Cancer Research Centre, is looking at new ways to effectively measure and manage cancer pain – with the aim of improving quality of life for people living with the disease.
Our reporter Anna Lacey went to meet Professor Fallon in Edinburgh, and started by discussing how we currently measure pain.
Pain relief package
"We often say to patients "on a scale of zero to ten, where zero is no pain at all and ten is the worst pain imaginable, where would you rate your pain?" And then we try to ask the patient, "what has been your worst pain in the last 24 hours?" Classically, for example with metastatic bone pain, a patient may have a background pain of as little as one or two out of ten, but when the patient moves, the pain may actually escalate to 9 or even 10 out of 10.
And although it escalates transiently, it can very debilitating to the patient, impact enormously on what they're able to do and their general quality of life. So the worst pain score is a very important question."
OBut the problem in many busy hospitals is that pain isn't routinely assessed. So to make sure it's given the attention it deserves, Marie and her team have developed a system called EPAT – which stands for the Edinburgh Pain Assessment Tool.
"The idea is that the patient is asked about their pain whenever they have their blood pressure, pulse and temperature taken. It uses a scale of zero to ten, and it's colour coded, ranging from green to amber to red – red being moderate to severe pain. And if the patient falls in the amber or red part of the scale, they then go on to step 2, which guides the nurse to come to decisions about the best treatment, along with discussion with medical staff.
Everyone is very enthusiastic about the new system and I think that's because they see that this is a simple concept but it's dealing with a real need. We know that fifty percent of patients with cancer in hospital have uncontrolled pain and we know that the majority of that pain should be able to be controlled reasonably easily using the simple steps that we have outlined."
Once pain has been measured, the next step is to find an appropriate way to treat it. Radiotherapy is often used to relieve bone pain, but it doesn't work for everyone. So Marie, with funding from Cancer Research UK, is running a clinical trial to see if a drug called pregabalin can improve radiotherapy's effects.
"This is a study looking at metastatic bone pain – that's cancer of any primary site that's spread to the bone. It's the commonest cause of pain from metastasis. The problem with bone pain is that it's particularly troublesome when the patient moves, or the pain can suddenly escalate when the patient's sitting at rest.
There are 230 patients included in the study. They're all receiving palliative radiotherapy for their metastatic bone pain, and we know that 25% of patients will get complete pain relief with [this treatment]. But that leaves a huge number of patients who don't get complete relief or partial relief. So at the time of radiotherapy, we're randomising patients to either receive pregabalin or current best standard care.
At the end of the study, which lasts for four weeks, the primary outcome will be "have the patients in the pregabalin group got better pain control?”" and have they managed to consume less morphine or at least remain on a stable dose.
The beauty of pregabalin, if it works, is the option to increase the pain relieving effects of radiotherapy, use pregabalin instead of radiotherapy in those patients who couldn't have radiotherapy for a whole variety of reasons, and we would be able to increase treatment choices dramatically for patients with malignant bone pain."
Another drug that is also potentially showing promise is ketamine – which some people may have heard of as being a 'clubbers' drug'. How are you going to try and use it in pain management?
"We know from our early work that in small doses it can be an excellent pain-relieving drug for nerve pain (neuropathic pain) but also inflammatory pain. It has been abused, and it is a drug of abuse. But interestingly all of these drugs of abuse, when they're used in pain control, behave in quite a different way.
So the Cancer Research UK-funded study is looking at cancer-related pain that's all neuropathic – that means it's all nerve pain. And they're going to be randomised to either receive ketamine or receive a placebo drug. At the end we would love to find that the ketamine group will have better pain control, and we suspect they'll probably need less morphine to control their pain."
For both of these studies, the team is collecting information on the exact characteristics of each person's pain and how they respond to different drugs. In future, this will hopefully help doctors match the right pain relief to the right person.
"The benefit of having this added information is that not only will we know that these drugs are useful in 'x' percentage of patients, but what we hope to be able to do is match up patient characteristics with the different treatments and say 'well if you have the following characteristics, this is the drug that is perhaps best for your pain.'"
15:36
We've reached the end once more so we hope you've enjoyed the podcast. Don't forget that your feedback is vital in helping us improve the show, so please send us your comments and suggestions by email to podcast@cancer.org.uk.
We'll be back next month with all the latest news from Cancer Research UK, so until then, goodbye!
- Credits:
- Presented and produced by Kat Arney
- News by Alison Ross and Kat Arney
- DPatient support package by Anna Lacey
- Original music written and performed by Kat Arney and Henry Scowcroft
- With special thanks to all the participants
