NHS to pilot blood test that detects over 50 cancers


An innovative blood test that may spot more than 50 types of cancer will be piloted by the NHS in a world-leading programme, chief executive Sir Simon Stevens has announced.


The Galleri blood test, developed by GRAIL, can detect early-stage cancers through a simple blood test, and will be piloted with 165,000 patients in a world-first deal struck by NHS England.


If the NHS programme shows the test also works as expected for people without symptoms it will be rolled out to become routinely available.


The GRAIL pilot, which is due to start in mid-2021, will involve 165,000 people. That will include 140,000 participants aged 50 to 79 who have no symptoms but will have annual blood tests for three years.


People will be identified through NHS records and approached to take part. Anyone with a positive test will be referred for investigation in the NHS. Another 25,000 people with possible cancer symptoms will also be offered testing to speed up their diagnosis after being referred to hospital in the normal way.


Results of these studies would be expected by 2023, and if outcomes are positive, then they would be expanded to involve around one million participants across 2024 and 2025.


NHS Chief Executive Sir Simon Stevens said:


“While the good news is that cancer survival is now at a record high, over a thousand people every day are newly diagnosed with cancer. Early detection – particularly for hard-to-treat conditions like ovarian and pancreatic cancer – has the potential to save many lives. This promising blood test could therefore be a game-changer in cancer care, helping thousands more people to get successful treatment. This trial again confirms that the NHS is at the forefront of cutting edge treatments and technology.”


Health and Social Care Secretary, Matt Hancock said:


“We are building a world-leading diagnostics industry in the UK – not just for coronavirus but for other diseases too. This exciting and ground-breaking new blood test from GRAIL will give us another tool to give more people the very best chance of survival, demonstrating how the UK continues to lead the way in using the latest innovative treatments to help patients.


“Many of us know a loved one who has battled against cancer and have seen first-hand the impact of this deadly disease.”


Professor Peter Johnson, National Clinical Director for Cancer at NHS England and improvement said:


“The NHS has set itself an ambitious target, to find three-quarters of cancers at an early stage, when they have the highest chance of cure. Tests like this may help us get there far faster, and I am excited to see how this cutting-edge technology will work out, as we test it in clinics across the NHS.”


Sir Harpal Kumar, President of GRAIL Europe, said:


“The Long Term Plan for cancer is one I’ve been immensely supportive of since it was published, and I applaud the NHS and the government for setting out these ambitious goals and road map to diagnosing cancers earlier.


“Galleri, a simple blood test that’s capable of detecting more than 50 cancers, is a ground-breaking and potentially life-saving advance that could have a tremendous human and economic benefit. “Grail is thrilled to partner with the NHS and UK government to support the NHS Long Term Plan for earlier cancer diagnosis, and we are eager to bring our technology to patients in the UK as quickly as we can. I’m delighted we have the opportunity to work together to see if we can save many thousands more lives from cancer in the UK every year.”


Lord David Prior, Chair of NHS England said:


“Every year nearly 200,000 people in the UK die from cancer. Many of these people are diagnosed too late for treatment to be effective. This collaboration between the NHS and GRAIL offers the chance for a wide range of cancers to be diagnosed much earlier and could fundamentally change the outlook for people with cancer.”


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Open letter from NHS leaders makes plea over cancer backlog


Fifty leaders from across the NHS and cancer community have written to the First Ministers of the devolved nations and to the Prime Minister calling on them to stand by their commitments to improve cancer survival throughout the covid-19 crisis.


Cancer Research UK (CRUK) has said it fears the backlog of patients waiting for treatment – built up during the first wave of the virus – will lead to reduced survival rates.


Nearly eight months since the first UK-wide lockdown, the charity says there is now a much clearer understanding of the impact the pandemic has had on cancer care.


In a statement accompanying the open letter, CRUK warns there are lessons that must be learned from the first wave of covid-19 as cases rise once more:


‘Cancer patients – and those who think they might have cancer – have already faced huge challenges this year with many worried about coming forward to their GP or going into hospital to get tests because of the risk of getting covid-19.


‘And, with a huge backlog of patients still waiting for screening, diagnostic tests and treatments, we fear that there will be a negative impact on cancer survival.’


The charity added: ‘The impact was felt right across the cancer pathway, with over three million people across the UK not able to go for cancer screening and thousands fewer people referred for tests for suspected cancer compared to normal.


‘Over 30,000 fewer people started their treatment than the same time last year too, and most cancer clinical trials were disrupted.


‘Because of the hard work of our amazing NHS staff, cancer services are getting back up and running and the situation is improving. The numbers of people being urgently referred for suspected cancer are almost back to the levels seen at the same time last year.


‘…But challenges still exist. For some cancer types, such as lung cancer or urological cancers, referral numbers are still well below where they were last year.


‘While trials are getting back up and running, this is happening slower than we would like. And even with increasing activity, there’s still huge numbers of people waiting for screening, diagnosis and treatment.


‘So it’s vital that cancer services and clinical trials can continue to recover and not go backwards again as covid-19 cases rise again.’


A new cancer recovery plan, which will supersede the current cancer strategy in Scotland and aid in the recovery and redesign of cancer services, is being finalised and expected to be published before the end of this year.


The open letter comes as the Scottish Parliament’s Health and Sport Committee call for an urgent investigation of the impact of cancelling non-covid care earlier this year to see whether such action should be taken again if virus cases continue to rise.


By Sarah Nimmo.


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New chemotherapy patient consent guidance launched


Recording of patient consent for cancer treatments such as chemotherapy is to be standardised across Scotland.


NHS boards are introducing guidance and forms, which doctors can use to “confidently explain benefits and to patients of their proposed treatment”.


Until now health boards had followed their own processes for systemic anti-cancer treatment (SACT), which includes chemotherapy and other treatments such as immunotherapy.


Changes had been called for by cancer clinicians across Scotland and the new guidance has been developed with Cancer Research UK.


At the start of the pandemic, oncologists were given the option of changing chemotherapy treatment regimes and using medicines normally deemed too expensive, after experts warned the outbreak had shifted the “balance of benefit to risk” for patients receiving chemotherapy.


Professor David Cameron, SACT Lead Clinician for the South East Scotland Cancer Network, sat on the group responsible for developing the new guidance.


“It’s great news for Scottish cancer patients that the same information and consent form will be used for a particular treatment, irrespective of where you are being treated in Scotland,” he said.


Dr Janine Mansi, Chair of the UK-wide group overseeing the development of the new forms, said: “Clinicians using these forms have commended their clarity, and recognise their use to confidently explain benefits and risks to patients of their proposed treatment.


“The forms are also a tool to improve the consistency of information between all healthcare professionals taking consent and their patients.


“We are delighted that Scotland has embraced this initiative, and working with the team from Scotland has enriched the content of the forms as we go through the three-year cycle of upgrading, and produce new forms for the remaining specialist groups.”


The new guidance and forms are now being introduced in NHS boards across Scotland and can be viewed on the Healthcare Improvement Scotland website.


by Henry Anderson


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Cancer patients reveal varying experiences of care


The experiences of cancer patients in Scotland range from receiving good support and care to difficulties getting diagnosed and stressful waits and delays, a new report has found.


More than 5,000 patients took part in a major survey asking about their experience of cancer care and support from diagnosis onwards, before the COVID pandemic.


There were almost twice as many positive than negative comments, with many saying they had confidence in the system and received good clinical care.


Charity Macmillan Cancer Support, which funded the Scottish Cancer Patient Experience Survey together with the Scottish Government, says the findings underline why personalised care must remain central to the cancer care system.


One female breast cancer patient who took part in the research commented: “Excellent care from beginning to end. Atmosphere was relaxed, staff friendly, while also very professional.”


A male patient described how his bowel cancer was initially picked up by the national screening programme.


“The link between this programme and my access to local cancer services was speedy and efficient,” he added.


But others reported more negative experiences, including poor care and inadequate support after treatment.


One female breast cancer patient said: “I felt I was not told the long-term effects of the treatment in enough detail.


“Once treatment ended, I felt lost and that the support I had just stopped dead. I still had many symptoms but didn’t know if that was the norm.”


A male patient treated for a haematological cancer highlighted concerns over pressures on staff.


He said: “There are so many people with cancer that the wards are very busy, so staff cannot spend much time with you, as there are others they must see.


“At the end of their 12-hour shift the nurses were very tired, so did what was necessary and went.


“Twelve hour shifts are an accountant’s way of cutting the number of staff and so costs, but it is detrimental to the care of patients.”


Janice Preston, head of Macmillan in Scotland, said: “Cancer doesn’t just affect people physically. It can affect every aspect of life, causing problems from debt to depression.


”Survey after survey has shown people with cancer need support to cope with the effects the illness has on their lives, from causing money worries, to leading to anxiety and depression.


“This new analysis highlights once again why people’s emotional, financial and practical support needs must be recognised as just as vital as good clinical care.”


Last month Health Secretary Jeane Freeman pledged inequalities exacerbated the COVID crisis will be the focus of a new recovery plan for cancer services.


A report has warned the NHS in Scotland is likely to only be able to carry out 60% of the cancer operations it was doing before the pandemic for the next two years due to infection control measures because of the virus.


Ms Preston added: “The past six months have been extremely challenging for the cancer care system and the new cancer recovery plan aims to get it back on track.


“We look forward to working with the Scottish Government to create a system that not only ensures people get rapid testing and treatment, but also support for the many problems cancer causes in every aspect of their lives.”


Ms Freeman said patient opinion will be “at the heart” of the development of the new Cancer Recovery Plan:


“We are investing £9 million to make Scotland the first country in the UK where cancer patients will have access to dedicated practical, financial, and emotional help through the Transforming Cancer Care partnership programme with Macmillan.


“The survey will help drive the work of the partnership in reflecting the new challenges of covid-19.


“The programme will help to ensure everyone with cancer is offered a personal care plan and access to the support they need, and make it easier for people to continue their personal and professional lives for as long as possible whilst under-going cancer treatment.”



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Boots launch online cancer support service


A new free online service will offer a new, accessible route for those affected by cancer to speak to a trained healthcare professional from the comfort of their own home.


Boots, in partnership with Macmillan Cancer Support, has over 2,000 trained Boots Macmillan Information Pharmacists (BMIPs), offering specialist information and support on cancer, its treatment and possible side effects. This has been an important community role that Boots pharmacists have provided since 2012, and in just the last year, it is estimated that its pharmacists have had over 91,500 conversations to support people who are living with cancer or caring for people living with cancer.


To offer continued support from the BMIPs during lockdown and beyond, Boots has worked with digital healthcare provider Livi, to make this service available digitally and free of charge so more people who are shielding or would prefer to stay at home, can still access this important service.


Jonathan, who accessed the BMIP service after going through cancer treatment, said:


“After treatment, I felt like I couldn’t talk to anyone, I often didn’t want to disturb people, or I didn’t want to book or make appointments. The Boots Macmillan Information Pharmacist service is a great starting point – especially for those who, like me, might feel overwhelmed if they have been diagnosed. I think that this service is essential for people living with cancer. Speaking to someone who has Macmillan training reassured me. I’m glad that it’s now being made more accessible throughout COVID-19, when people may be feeling even more alone and isolated as they start or go through cancer treatment.”


Hafsa Dasu, a Boots Macmillan Information Pharmacist, who is one of the first to deliver this new digital service, said:


“We know that many people are nervous about going out, and access to healthcare professionals is restricted at the moment, so being able to access a pharmacist and ask questions that they might have forgotten to ask their consultant, or accessing some additional support because they might be feeling lonely or scared is so important. I’ve been a BMIP for seven years now, and it is something that’s incredibly close to my heart after several people close to me have been affected by cancer. I feel very passionate about being able to help people and provide reassurance while they are often feeling at their most vulnerable.”


Dany Bell, Treatment, Medicines & Genomics Strategic Advisor at Macmillan Cancer Support, said:


“Before Coronavirus, many patients told us that being diagnosed with cancer and going through treatment was the scariest thing that they could imagine. These anxieties and concerns haven’t gone away – they’ve been made worse by the pandemic.


“Now, many people are also contending with isolation from loved ones as they continue to shield, uncertainty around treatment and concerns about their increased risk of contracting the virus. It is vital that people with cancer can continue to access support safely as lockdown eases, which is why we are delighted that the BMIP service is available online, allowing people to get support and advice from trained professionals from the comfort of their own homes.”


The new service will be facilitated by Boots’ digital health partner, Livi, via its online platform. Juliet Bauer, UK MD of Livi, said:


The coronavirus outbreak has highlighted the critical need for better access to high-quality digital healthcare. At Livi, we want to ensure everyone gets the expert medical care they need, at the touch of a button. Coronavirus has shown digital technology can play a vital role in helping maintain continuity of care for some of our most vulnerable or in need.


“Our partnership with Boots means those affected by cancer can quickly and safely consult with trained healthcare professionals. This is particularly paramount at this time, when access to healthcare may have been disrupted due to the pandemic.”



Study sheds light on how cells can sense cancer


New therapies could be developed after researchers gain fresh insight into how cells alert the body when they are in danger of becoming cancerous.


A mechanism that forms a natural part of the ageing process could be used to help the body detect cancer cells sooner so they can be removed before tumours are formed, according to scientists at the University of Edinburgh. Scientists have discovered that regular cells can take on characteristics of immune cells, which can send warning signs when they are stressed or in danger.


This mechanism is part of the body’s system for removing older cells, a natural part of the ageing process, known as senescence. Researchers say the system may also help the body detect cancer cells sooner so that they can be removed before tumours form.


Senescence stops cells from dividing and prevents damaged cells from continuing to grow. The process is prompted by stress to the cell. It is also triggered when genes that have the potential to cause cancer – called oncogenes – become active.


Researchers at the University of Edinburgh found that key immune molecules inside cells, called TLR2 and TLR10, detect when oncogenes are switched on. This initiates a cascade of chemical signals that cause inflammation and trigger immune cells to remove the damaged cell.


Dr Juan-Carlos Acosta, Cancer Research UK (CRUK) career development fellow at the University of Edinburgh, said:

“The results of the study extend our knowledge of molecular mechanisms controlling senescence and may lead to new strategies for the development of anti-cancer and anti-ageing therapeutics based on innate-immune receptor manipulation.”

TLR2 and TLR10 were known to be important for detecting infections such as bacteria and viruses, but this is the first time they have been found to play a key role in ordinary cell ageing. The study, published in Science Advances, was carried out at the CRUK Edinburgh Centre at the University of Edinburgh.

“Damaged cancer-causing cells become senescent and are then killed by the body’s own immune system,” explains Dr Matthew Hoare, clinician scientist and honorary consultant from the CRUK Cambridge Institute. However, if the immune system does not destroy the senescent cell, the surrounding tissue can become inflamed, promoting cancer development.

“This is a really hot area for research, as senescence has the potential to stop cancer development in the earliest stages. These findings show for the first time that damaged cancer-causing cells use TLR2/10 signalling to become inflamed, presenting potential drug targets that could help the body clear senescent cells before they cause harm.”


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