Why diagnostics is the next big challenge for NHS cancer services
The next decade will see a new wave of advanced biotech capable of assisting enormous strides forward in cancer care, with potential for safer, more effective treatment, improved survival and a better quality of life for patients says Oli Hudson, content director at Wilmington Healthcare.
The pharmaceutical picture is exciting, and the principle of ‘personalised’ or ‘precision’ medicine is one that is increasingly expected to revolutionise cancer treatment – but its success depends on a parallel development in companion diagnostics.
In short, this field involves bioanalytical methods designed to assess whether a patient will respond favourably to a specific medical treatment or not and the science in this field is advancing rapidly.
Pharma now needs to collaborate with diagnostics manufacturers, testing laboratories, health informatics, commissioners, and regulators in order to provide a viable, safe and cost-effective treatment pathway.
In addition, the role of the patient is paramount, and a large-scale data gathering exercise is required to establish which patient populations will benefit from which therapies. It is likely that industry will need the help of healthcare systems to map patient populations and get a better sense of what will work on whom, and for which conditions.
Diagnostics in the NHS
With this as the background, cancer diagnosis has been put front and centre by the UK government, and in England the 2019 NHS Long-Term Plan has set in place two ambitious targets.
By 2028, the proportion of cancers diagnosed at stages one and two should rise from around half to three quarters of cancer patients. Then, from 2028, 55 000 more people each year should survive their cancer for at least five years following diagnosis.
These two targets are intended to reinforce each other: we know that many cancers become more survivable if captured early, at stages one and two. And in order to capture them early, we need early diagnosis.
To make this a reality, the long term plan has put in place two key pieces of infrastructure. The first is cancer alliances, groups of cancer clinicians that will drive the development of cancer pathways at a local level; the second is the emergence of rapid diagnostic centres.
Currently existing in pilot form, rapid diagnostics centres are multi-disciplinary and can cover much of the data gathering work mentioned above.
They provide a single point of access to a diagnostic pathway for all patients with symptoms that could indicate cancer, and a personalised, accurate and timely diagnosis of patients’ symptoms. They combine all existing diagnostic provision and use networked expertise and information.
Success will depend on corralling many disparate resources in the NHS – including GPs, who form a big part of this as they, supported by the local alliance’s clinical network, will refer patients with suspected symptoms to RDCs. These can be non-specific – for example, lung cancer at an early stage can resemble a common cold, and the greater provision provided by RDCs and their networks can help pick this up.
As you can see from the map, they are currently clustered around the vanguard areas of London and Manchester, but by the idea is for the cancer alliances to take this forward so that all areas of England will be covered by 2023.
This is especially important as speed of diagnosis and cancer survival varies widely by healthcare community. Access to diagnostics services and therapies, and the outcomes from them, can depend on where you live. Research by Wilmington Healthcare has shown that lung cancer is a particularly variable type. Most diagnoses are at stage 4, by which stage the cancer is much less survivable. How likely a patient is to come forward before that is affected by a variety of factors such as an area’s deprivation, population, and quality of screening services.
If NHS diagnostics is enabled in the way the government wants, and is matched with the rollout of precision medicine, this will begin to happen less, with patients more likely to be given an effective therapy.
Conclusion
The roll-out of high quality and fast diagnostic services across the country, and the concomitant development of personalised medicine with companion diagnostics could be transformative; but it will also require close and co-operative working between the NHS, the pharma and diagnostics industries.
If they can get this right, progress against the disease could be considerable, and if the long-term plan’s targets are met we can consider this a great leap forward. And, as the industry has suggested, while cancer may lead the way in this process, there is scope for personalised medicine and companion diagnostics to transform the way we treat other conditions such as asthma, diabetes, arthritis and Alzheimers’- and even some mental health conditions.