Day four of the conference starts to see proceedings wind down. Although the quantity of sessions and talks may be less, the high quality remains much the same.
Don’t Quit On Us Campaign, Smoking Cessation and E-Cigarettes
Keeping with the theme of prevention, I attended the morning parallel session that covered smoking cessation, much by default than anything else. However, I was not to be disappointed, with some very intriguing data on the smoking behaviour of the nation presented across the three talks.
In the last 5 years the use of e-cigarettes as an aid to quit smoking has risen sharply, and now represents by far the most common method that smokers will use in their effort to quit. In the first half of 2017 alone, 20% of all attempts to quit smoking were successful. Records show this recent success is significantly greater than those reported in the previous ten years. Drilling further down into the data, it transpires that of the different types of e-cigarettes available, the daily tank form was associated with more successful quit attempts. As the name implies, daily tank e-cigarettes allow people to refill daily. Based on all the evidence, Leonie Brose, suggested it would be wise to promote the use of e-cigarettes as an intervention for smoking cessation.
In the next talk, Linda Bauld, Professor of Health Policy and Chair of Behavioural Change for Cancer Prevention at Stirling University, set the vision for a tobacco free Britain by 2035. This criteria is deemed to be met when less than 5% of the population smoke. Currently 19% smoke, so we still have some way to go. Although there is much encouragement, if not complacency, to be taken from this figure as up to 50% of the population smoked 40-50 years ago. Key to achieving the 5% mark, will be to ensure that today’s children never start smoking, with parents set to play an important role in influencing this outcome. Professor Bauld went on to add the other avenues that should be pursued are further reductions on the supply of cigarettes, and tighter restrictions on the marketing of all tobacco products.
Like many other things in the health service, smoking cessation services face difficult times as their current level of funding and other resources looks under threat. It is noteworthy to mention that people are more likely to quit if they utilised a stop smoking service than if they tried to quit of their own accord. The greatest success is achieved when people combine the use of e-cigarettes with a smoking cessation service. Statistics indicate that only 25% of people relapse a year after they have stopped smoking, meaning the majority who manage to quit for over a year are likely to remain lifelong non-smokers. Echoing Professor Baulds closing comments – as smoking cessation is dirt cheap compared to other things we pay for in the NHS related to cancer, it would be unwise to overlook these vital services that clearly have a measurable impact.
Early Integration of Palliative Care – Why it Matters
Professor Irene Higginson OBE, Director of The Cicely Saunders Centre for Palliative Care, Kings College, London, gave a very inspirational talk on the subject of palliative care. This has long been considered something difficult to talk about, yet is a branch of medicine in which Wales, through the pioneering work of Baroness Laura Finley, very much led the way.
Professor Higginson immediately challenged the audience about the way they view palliative care. The old world view of palliative care is that it is something given at the end of life. This perception has not been helped when we talk about cancer as a fight and a battle. When spoken of in this terms, palliative care is then often construed as admitting defeat.
However, the modern definition of palliative changes all this. Level 1 evidence shows the early intervention of palliative care can not only lead to a better quality of life, but may also improve survival. Palliative care should now be considered for use alongside curative treatment, as the two seemingly disparate approaches actually compliment one another. Palliative care puts the person first, before the disease, and it is just as much about rehabilitation as it is about end of life. Research shows that palliative care, when given early, can actually reduce the overall costs of cancer treatment, as well as providing a better patient experience -which must always take priority.
Moving forward, Professor Higginson would like to see standard systems put in place that better identifies people in need, and the implementation of tools whereby palliative care outcomes can be measured and recorded more accurately, than is currently the case. More leaders are also going to be needed in the field, those who can maintain the momentum, yet provide direction in a quickly evolving discipline. At the end of an enlightening and uplifting lecture, Professor Higginson left us with some very poignant quotes from Cicely Saunders – “you matter because you are you, and you matter all the days of your life, including the end of your life” and “we will do all we can not only to help you die but to live until you die”.
It is up to us – the funding bodies to help these inspiration people achieve these important goals.
DNA Damage, Cell Responses and Eureka Moments from the Lab
The very last lecture of the whole conference was given by Steve Jackson from Cambridge. His presentation began with a reminder that a thorough understanding of DNA repair is hugely important for cancer, more so than the other molecular sciences. As Professor Jackson began to unfold the story behind the discovery of Olaparib, the very first therapy to target DNA repair, it was hard not to agree.
It is a frightening thought that the DNA contained in every cell in our body, will experience ~ 100,000 lesions, per day. It’s is a testimony to how fearfully and wonderfully made we are, that the vast majority of these lesions will be corrected by the DNA repair machinery, a molecular first aid kit that also resides in each cell. It is Professor Jacksons lifelong pursuit of deciphering how these many complex mechanisms operate, that has given rise to the first therapies that can specifically target DNA repair, and selectively kill cancer cells whilst sparing normal tissue. While Olaparib is currently indicated for BRCA mutated ovarian cancer, it is beginning to find its way into the treatment of prostate and breast cancer, and indeed for cancers outside of the BRCA setting.
Professor Jackson’s lab are continuing to fathom the mechanisms of drug resistance at the level of DNA. Using the novel approach of synthetic viability (as opposed to synthetic lethality) his team hope to uncover more Achilles heels hidden within DNA, with the potential to discover and develop more cancer drugs of this class. Professor Jackson left us with a tantalising thought that – one day we may be able to chase cancer down a blind alley from which it has no escape. Roll on that day!
See You Next Year in Glasgow
As is customary at the close of every NCRI conference, incoming chairperson, Professor Margaret Frome, introduced some of the research areas to be highlighted at next years conference in Glasgow, and the list of speakers due to attend. While I will miss Liverpool, I do very much look forward to Glasgow, with its rich cancer research environment. Finally, I would like to thank the conference organisers, and all the NCRI partners for putting on another wonderful conference. See you next year !