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Cancer

The NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enable research to thrive. We work in partnership with the NHS, universities, local government, other research funders (including industry and charities), patients and the public to improve the health and wealth of the nation.

In 2017-18, the NIHR spent more than £31.5 million on research studies into cancer. The NIHR Clinical Research Network (CRN) supported 1,279 studies on cancer, 443 of which were new studies, and recruited 122,664 patients to studies last year (2018/19).

Improving radiotherapy treatment for low risk early stage breast cancer

Surgery is often the first treatment for breast cancer. Research has shown that having whole breast radiotherapy after breast conserving surgery reduces the risk of the cancer coming back (relapse). However, breast cancer patients may experience long term side effects from whole breast radiotherapy. For example, their breasts may become harder or smaller.

Currently, patients have full dose radiotherapy to the whole breast after surgery even if they are considered at relatively low risk of their cancer coming back. In this large group of women, doctors set out to test the benefits of radiotherapy restricted to where cancer used to be (‘partial breast radiotherapy’), or a full dose restricted to where the cancer used to be and low dose radiotherapy to the rest of the breast (‘reduced dose radiotherapy’).

The aim of the IMPORT LOW trial was to compare these two approaches to standard whole breast radiotherapy in a group of women with early breast cancer who were at a low risk of relapse.

Treating bone metastases in prostate cancer

Prostate cancer is one of the most common cancers in men in the UK. In the advanced stages - when the cancer has spread (metastisised), commonly to bone - there is no cure. Unlike in other types of cancer, deaths from prostate cancer are often due to bone disease and its complications. Whilst some prostate cancer drugs provide pain relief, they have not been shown to improve patient survival.

With the knowledge that radium-223 selectively targets the spread of cancer cells to bone, researchers from the NIHR Royal Marsden Biomedical Research Centre trialled radium-223 in men with advanced prostate cancer. The phase 3 trial, which involved 921 patients receiving either radium-223 or a placebo, showed at the point of interim analysis that radium-223 could boost patient survival by 30% in those with advanced prostate cancer.

In December 2014, draft NICE guidance approved radium-223 for the treatment of men with bone metastatic castration resistant prostate cancer. It has since been licensed and is now available for use in England via the Cancer Drugs Fund.

Find a cancer study in your area

You can find out more about cancer studies in your area through the Be Part of Research website.


The NIHR provides researchers with the practical support they need to make clinical studies happen in the NHS and social care. 

We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.

We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.

The Cancer Specialty is one of over 30 specialties that bring together communities of clinical practice to provide national networks of research expertise. Our membership is made up of research-interested clinicians and practitioners at both national and local level. Our role is to ensure that the cancer studies included in our national portfolio of research receive the right support to ensure they are delivered successfully in the NHS - to time and target.

Key achievements of the Cancer Specialty include:

  • World-leading rates of cancer patient participation in clinical research
  • Continual increase in the recruitment of cancer patients to all studies and specifically to Randomised Controlled Trials and interventional studies
  • Growth in the portfolio of cancer studies year on year covering the full spectrum of cancer
  • NHS patients now have more opportunities to access treatment advances because studies are available nationally
  • Proving the link between research active trusts and better patient outcomes

Cancer is one of the largest specialty areas spanning all the different cancer types, focusing on improving diagnosis, treatment and prevention. We have a vast and diverse portfolio of over 1,000 studies that we support, which can be broken down into a number of disease areas across all ages, including the following:

  • Bladder and renal
  • Brain  
  • Breast  
  • Children's cancer and leukaemia  
  • Colorectal
  • Gynaecological  
  • Haematological oncology  
  • Head and neck  
  • Lung      
  • Lymphoma  
  • Palliative and supportive care
  • Primary care
  • Prostate
  • Psychosocial oncology and survivorship
  • Renal
  • Sarcoma
  • Skin cancer
  • Germ cell and Teenage and Young Adults
  • Upper gastrointestinal

On our website you can find out more about how your study can benefit from our Study Support Service, and the support available from our experts. For queries relating to delivering cancer studies in the NHS, please contact crncancer@nihr.ac.uk

Resources

Specialty Profile (for life sciences industry)

Find out what our Cancer Specialty can offer the life sciences industry and why you should place your study in England.

Chemotherapy and Pharmacy Advisory Service (CPAS)

The aim of CPAS is to help trials across the whole of our portfolio run as smoothly and quickly as possible, and to improve quality of care and management of risks in prescribing, preparing and administering cancer treatment. A review of current trials has raised a number of issues which have made trials difficult to implement at the local level and which have led to delays and problems in areas such as:

  • Dose adjustments
  • Dose capping
  • Missing pharmacy information
  • Supply of drugs
  • Labelling
  • Safe administration of systemic anti-cancer treatments

CPAS aims to help investigators through these problems, achieving some consistency across the NIHR. Investigators who have protocols reviewed in this way have reported that it was a helpful and constructive process which reduced the number of protocol amendments that were required during the trial. CPAS has produced a number of guidance documents to advise investigators on the drug content and details of their protocols, and to assist the review process. 

CPAS members are made up of oncology and haematology clinicians, pharmacists, pharmacy technicians and research nurses from NHS trusts across the UK. Members are required to have a minimum level of experience in delivery of cancer clinical trials. CPAS reviews clinical trial protocols, pharmacy manuals, patient information sheets and other trial documents. Members may be asked to complete an average of four reviews per year. For further information on becoming a CPAS reviewer please contact Mrs Jo Askey at joanna.askey@nihr.ac.uk

CPAS holds two meetings per year where members come together. One of these is for committee members specifically and one is open to all members. 

Surgical Oncology Research

Surgical oncology is vital in improving outcomes. Surgical technologies advance rapidly with a new era of diagnostics, robotic surgery, minimal access techniques, pre-optimisation and enhanced recovery. These innovations need proper evaluation in clinical trials to demonstrate which are clinically beneficial and cost-effective. Additionally, surgeons are often central in recruitment to the wider portfolio of multidisciplinary cancer trials. For example, surgeons are needed to help lead and recruit to window-of-opportunity studies and to assist in procurement of biospecimens for translational studies.

The NIHR's overall aim is to ensure access for all NHS patients to clinical trials from the extensive portfolio. It has specific objectives to recruit to challenging trials, and surgical oncology is specifically cited. To this end, the work of the NIHR includes a number of key initiatives which aim to encourage recruitment to surgical oncology trials.  

Recognition: Cancer Research Excellence in Surgical Trials (CREST) award

Since 2014 the NIHR has partnered with Swann-Morton on the CREST award. The award formally recognises the contribution of surgeons in recruiting patients to surgical and multidisciplinary cancer trials.

Linking with other stakeholders in Surgical Trials

The NIHR regularly links with Cancer Research UK (CRUK), Royal College of Surgeons of England (RCSEng), National Cancer Research Institute (NCRI) and Experimental Cancer Medicine Centres (ECMC) to foster joint initiatives to promote trials in surgical oncology.

Future of Surgery initiative: Following on from the 2012 NCRI Report, the NCRI jointly led a new surgical oncology initiative with the RCSEng: “Future of Surgery”. Five workshops and the published report highlight areas for future trial development as well as methodological issues common to surgical oncology.

Surgical Research Steering Committee: this committee meets three times per year to foster communication between the RCSEng clinical research initiative, the NIHR and the NCRI.

Surgical Oncology Portfolio: Defining and closely monitoring recruitment to portfolio of surgical trials

In order to better understand the trends, the NIHR reviewed the cancer portfolio to identify cancer trials that are recruited to by surgeons. These trials include not only those where surgery is the primary trial intervention but also multi modality trials where the surgeon leads recruitment.

Since 2015 there have been 174 surgical oncology trials open and recruiting. On average there are over 100 surgical oncology trials open in a year with recruitment sitting just under 12,000 for the last two years. Almost 9,000 were recruited to randomised controlled trials open in 2017/18, 73 per cent recruited to time and target.

Training and mentorship: Tomorrow’s Leaders Workshop

This workshop is aimed at trainees and early stage consultants with an interest in surgical oncology from any discipline, and any degree of prior research exposure. The curriculum features a hands-on, interactive small group design and includes the following:

  • Breakout sessions hosted by the NCRI clinical studies group with ‘dragon’s den’ style triaging of new trial proposals
  • Pearls and pitfalls of trial recruitment as an early year consultant
  • NIHR Good Clinical Practice (GCP) training and trial recruitment training, Granule course and the Associate PI scheme
  • How to access NIHR research support (“Can I have a research nurse?”)
  • The role of the trials unit in surgical trials
  • Exposure to surgical oncology trials ‘champions’, trial funders and trials units

Watch this space for information about Tomorrow's Leaders 2020. 

For enquiries please email tomorrows-leaders-2020@nihr.ac.uk

GeneRAtiNg sUrgicaL rEcruiters for randomised trials (GRANULE)

The GRANULE course has been created through the collaboration of the University of Bristol's QuinteT research group and MRC ConDuCT-II hub; the University of Birmingham's academic department of surgery and Cancer Research UK clinical trials unit; and other stakeholders. It is designed to equip researchers with the practical skills to recruit patients into randomised surgical trials. Researchers involved in any randomised controlled trial (RCT) may also find it helpful to draw upon these insights from surgical clinical studies. 

It focuses on the concept of ‘equipoise’, which means uncertainty over which treatment is best. Learners are taught to communicate this uncertainty to patients and the need to assess it within a trial. This means patients will be more likely to understand clinical research and to consent to take part in surgical trials. 

By completing this course you will:

  • Understand why we need randomised controlled surgical trials
  • Understand how to convey clinical equipoise, explain randomisation and address patient preferences
  • Be able to successfully recruit to randomised controlled trials in surgery

To register visit NIHR Learn where you will also find useful information about other courses we run.

Useful links:

RCSEng clinical research initiative 

NCRI reports on surgical oncology 

GCP training via NIHR learn

Working closely with key stakeholders, the Cancer Specialty has been enormously successful in integrating clinical research into NHS clinical service provision, and both developing and delivering a large practice changing portfolio of clinical trials. We have achieved this level of performance through our ‘whole system’ approach through:

  • Establishing clinical research as an integral part of optimal cancer care across the country
  • Working closely with Clinical Studies Groups who are involved in the development of high quality research proposals
  • Engaging with the life-sciences industry
  • Developing collaborations between academic investigators, clinicians and the life-sciences industry, giving NHS patients access to new agents that may improve outcomes 

European Organisation for the Research and Treatment of Cancer (EORTC)

The EORTC is an international research organisation based in Brussels, Belgium which aims to develop, conduct, coordinate, and stimulate laboratory and clinical research in Europe to improve survival and quality of life for cancer patients. EORTC is establishing a network of Liaison Offices to promote and facilitate collaboration between clinical cancer research groups across Europe. Liaison offices exist in Sweden, France and the UK.

The UK-based EORTC Liaison Office is supported by NIHR and Cancer Research UK and helps coordinate collaborative cancer clinical research between the UK and other international cancer research organisations, with a particular focus on that conducted by the EORTC.

Find out more on the EORTC website.

National Cancer Research Institute (NCRI)

The NCRI is a UK-wide partnership between research funders working together to make faster progress against cancer. The NCRI partners have funded more than £5.5bn of cancer research since 2002, and work together to maximise the use of these funds. The NIHR works in close collaboration with the NCRI to shape the development and delivery of studies.

The Cancer Research Excellence in Surgical Trials (CREST) award has been created by the NIHR and NCRI to recognise surgical teams who have made the greatest contribution in recruiting to the NIHR cancer trials portfolio. 

Find out more on the NCRI website.

Cancer Research UK (CRUK)

The NIHR has partnered with CRUK - along with the Health Departments for Scotland, Wales, and Northern Ireland - to fund the Experimental Cancer Medicine Centre (ECMC) Network.

Launched in 2007, the ECMC Network aims to act as an efficient and effective network that will assist in the delivery of early phase cancer studies between research partners to enable faster and more personalised patient benefit.

The ECMC Network works with the support of 18 adult and 9 paediatric centres distributed through Scotland, England, Northern Ireland, and Wales. The centres are associated with universities with capabilities in cancer research, and are linked to local NHS hospitals.

Find out more on the ECMC Network website.

The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.

NIHR Biomedical Research Centres

NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments for patients. The following BRCs undertake cancer research:

NIHR Medtech and In vitro diagnostics Co-operatives

NIHR Medtech and In vitro diagnostics Co-operatives (MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic tests. The following MICs undertake cancer research:

NIHR Clinical Research Facilities

NIHR Clinical Research Facilities (CRFs) are dedicated and purpose built facilities where specialist clinical research and support staff from universities and NHS Trusts work together on patient-orientated commercial and non-commercial experimental medicine studies. The following CRFs undertake cancer research:

Experimental Cancer Medicine Centres

The NIHR funds 14 Experimental Cancer Medicine Centres across England in close partnership with Cancer Research UK. ECMCs play a leading role in speeding up the process of cancer drug development and the search for cancer biomarkers that can be used to diagnose cancer, predict the aggressiveness of the disease, or show whether a drug will be effective in a specific patient and at what dose.

Work with our infrastructure

All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: nocri@nihr.ac.uk 

Our experts in the NIHR Clinical Research Network (National Specialty Leads) can advise on delivering your cancer study in the NHS. Due to its size and complexity, we have appointed six National Specialty Leads for cancer, each of whom is responsible for a key cross-cutting research theme.

Professor Richard Shaw

Professor Richard Shaw is the NIHR Clinical Research Network National Specialty Lead for Surgical Oncology.

Richard graduated in Bristol and Glasgow from primary degrees in dentistry and medicine. After surgical training in Glasgow, Richard moved to Liverpool in 2001 to undertake higher training in OMFS and subsequently a head and neck oncology fellowship. Integrated within this clinical training, Richard completed his thesis as a RCSEng Research Fellow, as well as DoH Genetics in Healthcare Fellowship at MD Anderson Cancer Centre, USA.

Richard was appointed to Liverpool University and Aintree in 2007, gaining his personal chair in 2012. Richard co-chairs the Mersey Head and Neck Oncology Research Group (MHNORG), an expanding and vibrant multidisciplinary collaboration of clinicians and scientists committed to improving understanding and treatment of malignancies of the mouth, throat and larynx.

Following several senior roles in the NCRI Clinical Studies Groups, Richard was appointed as an associate director of CRN (Cancer) with specific remit for advancing surgical oncology trials and the role of surgeons in the national cancer portfolio.

E: richard.shaw@liverpool.ac.uk

Dr Pippa Corrie

Dr Pippa Corrie is the NIHR Clinical Research Network National Specialty Lead for Late Phase and International Trials. 

Pippa qualified in medicine at Oxford University, having previously undertaken a PhD in anticancer drug development. She was appointed as Consultant Medical Oncologist at Addenbrooke’s Hospital, Cambridge in 1997 and is an Associate Lecturer in the University of Cambridge. She is the NIHR Clinical Research Network National Specialty Lead but also the local Cancer Specialty Lead for NIHR Clinical Research Network Eastern.

Her specialist and research interests are in melanoma and pancreaticobiliary cancers. She chaired the NCRI Skin Cancer Clinical Studies Group from 2012-2017 and is currently the NCRI Pancreatic Cancer Clinical Studies Subgroup Chair. She is Chief Investigator of several academic and commercial-sponsored NIHR portfolio melanoma and pancreatic cancer clinical trials.

As a melanoma specialist, she has been closely involved in the evolution of immunotherapy in research and clinical practice and has taught widely on aspects of their efficacy and toxicity management.

E: pippa.corrie@addenbrookes.nhs.uk

Dr Amos Burke

Dr Amos Burke is the NIHR Clinical Research Network National Specialty Lead for Children and Young People’s Cancer.

He is currently leading a national initiative to improve the availability of and recruitment to trials for Teenagers and Young Adults. Dr Burke is a childhood cancer specialist working at Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital where he has worked since 2004 providing a service for children in the East of England and where he has developed and leads the pioneering Brainbow rehabilitation service for children with brain tumours. He is also an expert in the field of childhood lymphoma and is a member of the National Cancer Research Institute Lymphoma Clinical Studies Group and chairs its paediatric Non-Hodgkin Lymphoma subgroup.

Dr Burke trained in Edinburgh, completing paediatric training in the Midlands, and South west. He undertook a PhD in Childhood Leukaemia in Bristol before appointment as a Consultant in Cambridge. He remains an active researcher in cancer biology of lymphomas as well as in clinical trials for which he is a Chief Investigator.

E: amos.burke@addenbrookes.nhs.uk

Professor Jonathan Wadsley

Professor Jonathan Wadsley has been NIHR Clinical Research Network National Specialty Lead for Radiotherapy and Imaging since December 2017.

He is a Clinical Oncologist specialising in the treatment of upper gastrointestinal, pancreatic and hepatobiliary, thyroid and neuroendocrine tumours. He also chairs the NCRI Thyroid Cancer Subgroup.

Professor Wadsley undertook his specialty training in Oxford and was appointed to a consultant post in Sheffield in 2004 where he is still based.

E: jonathan.wadsley@sth.nhs.uk

Professor Sarah Danson

Professor Sarah Danson is the NIHR Clinical Research Network National Specialty Lead for Early Phase Cancer Research.   

The main aim of this role is to improve equity of access to early phase trials.

Sarah is a Medical Oncologist specialising in the treatment of melanoma, lung cancer and the early clinical assessment of new anticancer agents. She was a Specialist Registrar in Medical Oncology and a Cancer Research UK Clinical Research Fellow in Pharmacology at the Christie Hospital, Manchester before moving to work for Weston Park Hospital and Sheffield University in 2006. Sarah was a member of the CRUK New Agents Committee from 2009-16 and currently sits on the NCRI Skin Cancer Clinical Studies Group and the EORTC (European Organisation for Research and Treatment of Cancer) Lung Cancer and Melanoma Groups. She has been Sheffield ECMC (Experimental Cancer Medicine Centre) Lead since 2016. 

E: s.danson@sheffield.ac.uk

Professor Sam Ahmedzai

Professor Sam Ahmedzai is the NIHR Clinical Research Network National Specialty Lead for Community-based, Supportive and Palliative Care Research.

He is Chair of the NCRI Supportive and Palliative Care Clinical Studies Group and head of the Academic Unit of Supportive Care in the University of Sheffield. He is a honorary consultant physician in palliative medicine, working in a hospital supportive care team and lead clinician for supportive and palliative care in the North Trent Cancer Network. Professor Ahmedzai also heads the Sheffield Adult Cancer Survivorship project.

He is editor-in-chief of the Oxford University Press book series on supportive care; the journal ‘Current Opinion in Supportive and Palliative Care‘; the section on supportive and palliative care for ‘BMJ Clinical Evidence‘; and the clinical lead for the NHS Evidence Specialist Collection for Supportive and Palliative Care.

E: s.ahmedzai@sheffield.ac.uk

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