Lifelong cancer care

While adult trials for many cancer immunotherapies are proceeding, paediatric cancer researchers face a unique set of challenges in bringing these more specialised treatments to trial. Paediatric Oncologist Dr Juliet Gray, at the University, is developing two antibody treatments for children with neuroblastoma, one of the more aggressive childhood cancers, as a less toxic alternative to chemotherapy.

“There are a number of things that make conducting this type of clinical trial i children very challenging. Therefore, it is important that we learn as much as we can in the laboratory, in advance of clinical trial, about how this type of therapy can best be used in childhood cancers,” says Juliet.

Juliet is hopeful that a paediatric trial of immune-stimulating antibodies can begin within the next five years. She is also examining how Anti-GD2 antibodies work to kill neuroblastoma cells. These antibodies directly target neuroblastoma cells, and are already used clinically in children. Her work is focused on monitoring the effects of these antibodies in children, and developing ways of making them more efficient. The promising results of immunotherapy trials suggest that harnessing the healing power of the immune system is the future of cancer treatment. While chemotherapy and other treatments narrowly target the cancer, it often develops new ways of growing.

Advances in prevention, diagnosis and treatment such as immunotherapy mean more and more people are surviving cancer; it is estimated that around two million people are living with, or beyond, cancer in the UK, with this figure expected to double by 2030.

Therefore, researchers from the Macmillan Survivorship Research Group (MSRG), at the University, funded by Macmillan Cancer Support, are conducting a programme of research to understand the needs of cancer survivors, identify what helps or hinders their recovery of health and wellbeing, and identifying and testing new ways to support them. The team has developed the first study of its kind looking at the experiences and needs of people after primary treatment of colorectal cancer.

The University of Southampton has a long standing history of cancer research and has established the ColoREctal Wellbeing (CREW) cohort to look at a number of factors influencing recovery which takes into account the disease itself, the level of treatment patients receive, the type of problems they are experiencing, the support available to them and how they can be supported to manage problems for themselves.

Factors influencing recovery studied within the research include the time it takes a patient to return to feeling ‘well’, the length of time symptoms of treatment last and the range of things people can do to help return to ‘normal’ more quickly, explains Dr Claire Foster, Chief Investigator and Head of MSRG. “The idea of the CREW study came from some research we did several years ago, also funded by Macmillan, involving cancer patients and people that were affected by cancer, across the UK. We asked them what was important to them in the sorts of research that we should be doing” says Claire. “And the priority for them was for us to start thinking about the impact of cancer on everyday life,” she adds.

The sorts of questions that the study asks participants range from how they cope with everyday tasks, how side-effects and consequences of treatments impact on their lives, the kind of support that they and their families get from healthcare services, and how confident they feel in coping and self-managing their condition.

More than 1,000 participants have been recruited to the study from 30 cancer centres across the UK. Cancer tends to affect people in later life, so the average age of people in the cohort is 68. “So many participants are retired. We are also asking whether they are living with other conditions such as arthritis and heart disease, that might complicate their recovery,” says Claire.

The longitudinal study follows participants over a number of years to establish the natural history of their recovery and wellbeing to assess how quickly they recover. “At the moment, we don’t really know what the pattern of recovery is for patients. A real strength of this study is that we are asking people to tell us how they feel even before they have started their treatment, in order to map a typical course of recovery of health and wellbeing,” says Claire.

Results from this rigorous theory-based study will, for the first time, inform healthcare providers and professionals across the country about what helps or hinders rapid and effective recovery and who has the confidence and ability to manage their own challenges. It will also help identify areas for the development of interventions to aid the recovery process of those who may be at risk of experiencing problems.

The Southampton MSRG collaborates with researchers internationally, so that comparisons can be made between different groups of patients across the world. Claire believes that the CREW study will have international significance because colorectal cancer is the most common cancer that affects both men and women. “Some of the experiences of our participants will be similar to people in other healthcare settings; it is not just the impact on the NHS, it is the impact on healthcare systems globally and the impact on the patients’ everyday life.”

Ciarán Devane, Chief Executive of Macmillan Cancer Support, says: “The CREW study is important in helping us learn more about bowel cancer patients and their different needs after treatment. The information gained through research will help us support and improve the lives of the increasing numbers of people who are living with and beyond cancer.”