Dr Jeanette Dickson
Vice-President for Clinical Oncology, RCR
RCR Vice-President for Clinical Oncology Dr Jeanette Dickson shares her thoughts on the major developments in her speciality during the past 70 years and looks ahead to future advances as the national health service turns 70.
Recently, media and political attention has, understandably, focused heavily on the challenges facing the NHS as it marks its 70th birthday, especially in relation to workforce and long-term sustainability.
Cancer remains firmly in the political spotlight, and I think there is a huge amount to celebrate about the NHS and advances in clinical oncology over the past 70 years. More than most specialties, clinical oncology has seen massive advances in the evidence base, treatment delivery technologies and drug development. In addition, there has been a welcome inclusion of the patient in their own healthcare decisions. Going forward, the future remains promising with continued, exciting developments on the horizon.
Before CT and MRI, clinicians determined the position of cancer via skin landmarks and two-dimensional X-rays.
In 2018, the NHS will deliver more than 130,000 courses of radiotherapy, all supported by a robust evidence base, much of which has been established by UK generated trials. The evolution of imaging techniques over the past 70 years has had a direct impact on advancements in radiotherapy. Before CT and MRI, clinicians determined the position of cancer via skin landmarks and two-dimensional X-rays. Fusion of state-of-the-art cross-sectional and, increasingly, functional imaging with radiotherapy planning scans now allows clinical oncologists to map precisely the location of the cancer and modify that treatment in real-time thanks to ‘on board’ imaging.
The evolution of cancer treatment
Later this year, we will see the launch of fully commissioned, UK-based, high energy proton beam therapy. This will especially benefit the youngest cancer patients and those with very rare tumours, adjacent to critical structures such as the brain stem. There will also be a strong underpinning research programme, which will develop the evidence base around this exciting particle therapy.
Over the next ten years, we should start to realise the potential of magnetic resonance scanner-enabled LINACs, which can monitor changes in tumour position during the delivery of radiotherapy. This fusing of different imaging modalities will allow real time adaptation of radiotherapy treatment plans around tumour and normal tissue movement, minimising the impact of radiation on normal tissue.
Great strides are being made
Great strides are anticipated when newer immunotherapy drugs are used in combination with radiotherapy, and we hope that these systemic therapies will work to boost the local tissue immune-related changes that radiotherapy produces.
We look forward to a time in the not-too-distant future when advances in genomics will mean cancer patients have their tumours ‘decoded’, enabling clinicians to prescribe targeted, fully personalised systemic and radiotherapy for each individual.
Overall the NHS and clinical oncology have travelled a great distance over the past 70 years. We hope the coming decades will build on improved therapies and increased patient access feeding through into improved patient outcomes.