Cancer research ‘sales’ to patients remain flat

Today sees the annual Cancer Patient Experience Survey published.

For the third year running it looks at the extent to which people with cancer are being told about the opportunity to take part in research. Also, how many take up that opportunity. National data is published and then statistics are provided by NHS Trust and tumour type.

The results are not that encouraging. Since the survey started including questions about research, the dial has been stuck at less than 1 in 3 people having that possibly life-saving conversation with their doctor. If anything there is a slight trend downwards  In 2012 it was 33%, inn 2013 it was 32% and 2014, 31% (see pages 61 onwards of the report).  If you have brain or haematological cancer the figure is 37%. If you have skin or urological cancer it’s 17% and 14% respectively.

I am sure some people would say the drift downward is a statistically insignificant drop. But consider this.

For arguments sake, say cancer research is a business. And say patients with cancer are its customers. Then in business terminology we would be informing the stock market that sales are flat, the growth forecast is poor, and there may be a case for issuing a profits warning. And we all know what has happened to even our biggest companies like Tesco when this happens.

What are the causes for this lack of ‘growth’ in the numbers of people with cancer being offered the opportunity to be part of a clinical trial? Why is this happening in a clinical area which had had the longest run-up at promoting research to patients?

I don’t know for sure, is the answer. But I hope that it is an agenda item at the next board meeting of the National Cancer Research Institute (NCRI). Finding out why and putting in measures for improvement will be important.
Arguably, for instance, the cancer patient experience survey should be one of its performance measures. Personally I would like to see us aim for results nearer 50% and 80% by 2016 and 2019 respectively. Arbitrary perhaps but we need to be aiming for something.

I do have an opinion as to what’s not happening. It may be wrong. Nor is it likely to be the whole picture. But it’s based on conversations with public involvement colleagues in cancer and others around the country over recent months.

I think our consumer groups in cancer are not being listened to as much as they should be. I think ‘change’ may be drawing them away from the business at hand. I think that they are not being given the funding and support necessary to be what they can be – an important part of the ‘sales force’ that delivers on the NHS Constitution pledge that every patient has a right to information about research. Finally, I think we are failing to engage their colleagues in the NHS workforce sufficiently in this agenda. But that goes for all conditions.

If I were invited to that next NCRI Board Meeting I would be encouraging them to look at NIHR’s strategic framework for increasing participation in research ‘Promoting a research active nation.’ It doesn’t hold all the answers. However, I would be suggesting they look at how to translate its clear and considered approach – from the research ambassadors programme to the ‘OK to ask’ campaign – to cancer. And then to back it strongly.

There are some reasons to be optimistic. The members of the NCRI Consumer Liaison Group are a formidable force and well-led. Our cancer researchers and clinicians are committed. Cancer Research UK now has a public engagement strategy, budget and team in place and will be putting more weight behind this agenda in the next 12 months. Let’s hope other cancer charities follow suit.

For this results is not good enough for people with cancer and their families.

Even pharma must understand the perils of Schwanning about in a storm

On New Year’s Eve I took my family up ‘The Shard,’ London’s newest and tallest landmark.  As we looked Eastwards a squall was readying itself over the North Downs; the latest in a succession of storms to batter our shores over the past few weeks.  Low-flying clouds threatened to swallow us whole.  The wind roared around the open viewing platform.

In the run up to New Year’s Day, some of our media and politicians concocted a storm of sorts about the opening up of our borders to Romanians and Bulgarians.  For a so-called tolerant country we certainly know how to serve up vindictiveness and prejudice on a repulsive scale don’t we?

Fact is we probably have more to fear from the Chief Executives of Swiss-based pharmaceutical companies. For they seem all too ready to serve up damaging judgements on the UK’s health system.  Earlier in 2013 I had cause to write about those chocolate teapot moralists from Novartis .  They had felt it necessary to call an emergency meeting in London to admonish us about how the state of clinical research here (I hope they got my Xmas card with its personal message about the UK achieving ‘first global patient into trial’ in 23 commercial studies during 2013).

Then, over the holidays, the CEO of Roche Severin Schwan decided to fall back on tales told to him by a few mates who have lived in other countries as evidence for telling The Times (paywall) that the UK doesn’t value life.  Perhaps they were just happier because they could buy it?  I’m afraid the rest of the interview – and a broader contextual piece about pharma in The Economist in which Schwan also features - just goes to prove that Mr Schwan and his colleagues know ‘the price of everything and the value of nothing’ as my mother would put it.

Last year, the pharmaceutical industry was buffeted by the successful #AllTrials campaign calling for all clinical trial results to be published and to be made available.  The focus and intent of the campaign was strongly endorsed by the House of Commons Science and Technology Select Committee.  Industry execs probably thought they were through the worst of it with the deal hatched in Brussels just before Christmas over the new EU Clinical Trials Regulation.

How wrong they were.  Today’s report by the House of Commons Public Accounts Committee just shows it was the eye of the storm.  There will be no let-up in this drive for greater openness and transparency until practices change for the good and for good. And we are a long way from it happening just yet.

With a £12 billion profit to hand surely even Mr Schwan and his top execs can afford to see that there is an ethical and moral bottom line in play here?

A Very Happy New Year by the way.

 

 

 

Big month in Brussels for clinical trials…but let’s not be hasty

It’s going to be a ‘big-ish’ month in the EU for clinical trials.

By most accounts, EU legislators will reach a compromise agreement on the proposed new Clinical Trials Regulation in time for Christmas.  The key focus for industry bodies is around making sure the legislation embraces aggressive timelines for the approval of clinical trials.

Remind me, isn’t there a well-known saying about ‘haste’ and ‘speed?’

Anyway, I am afraid industry interests dominate the corridors and bars of Brussels and most of the self-proclaimed ‘patient-groups’ lobbying on this legislation bought into the corporatisation of clinical research long ago.  So, what we have had is lots of industry positioning coolly argued as meeting ‘patient need,’ but very little acknowledgement of patient rights.

Last week the industry-backed European Federation for Good Clinical Practice (EFGCP) sent out their report of the ‘Multi-Stakeholder Roundtable Meeting on Sharing Clinical Trial Data in the Interest of Patients and Research’ which they hosted in October.  I was struck by this quote from the report:

“One – perhaps unexpected – outcome was a focus on the participants in clinical trials. “We have to do a lot more to get back to individual patients involved in clinical trials,” said Ingrid Klingmann (EFGCP). “We owe that to patients for their willingness to contribute to the trial. At present that concept is not embedded in the proposed Regulation – but as a fundamental right it should be.”

Perhaps it was unexpected because there hasn’t been any meaningful dialogue with patients about what they want from clinical trials.  And I don’t just mean about the outcome of such research, but how people would like these studies to be conducted.

Question is….have EFGCP and others listened to the patient voice?  And, if they have, whether we can expect them to urge for the legislation to embrace the right of people to receive the results of trials they have been part of and for all studies to involve patients and the public to be involved in their design.

Must go. Haven’t quite finished my letter to Santa.

 

 

@RBandH Guest blog: Promoting Clinical Research Locally – From ‘OK to Ask’ to Research Changed my Life

Promoting Clinical Research Activities and Opportunities Locally – From OK to Ask to Research Changed my Life

Mark Terry, Research Office, Royal Brompton & Harefield NHS Foundation Trust (m.terry@rbht.nhs.uk)

2013 has been notable for the strong momentum provided by National Institute for Health Research (NIHR) to NHS Trusts in our efforts to raise awareness of research activities to the public, and to promote research opportunities to patients. At Royal Brompton & Harefield NHS Foundation Trust (RB&HFT) we have utilised this national focus on awareness and engagement, to actively promote patient/public involvement in the design of high quality research but also engagement with our research portfolio and wider opportunities available.

RB&HFT is a leading specialist centre for heart and lung research, with an international reputation for cutting-edge research and an identity which positions clinical research as integral to the core mission of the Trust. It should have come as a surprise that, following a local replication of the NIHR mystery shopper exercise , we faired only marginally better than the (very poor) national average for the availability of useful research information. However, prior to these results, it was recognised that we could do much more, and as a result of the NIHR spotlight, a Research Awareness Working Group (RAWG) was established to deliver an initial set of priority actions, followed by the development of sustainable, long-terms plans to ensure that patients/public are empowered with greater access to improved research information. As the group was getting going, NIHR launched the “OK to ask about clinical research” campaign, which focussed our attention upon ensuring that, should a patient or a member of the public feel empowered to ask, they would receive a structured, positive response every single time.

As such, RAWG identified that patient/public facing promotional materials would be required, and should be placed in high visibility areas of the hospital buildings, a staff training needs analysis would be needed to identify which staff groups (clinical and non-clinical) patients and the public pose questions about research to, and a wholesale revamp of the research pages on the corporate website and staff intranet would be needed to act as a current, accessible information source.

We have now implemented an initial action plan and are confident that patients/public will now be able to easily access useful information. Posters with the tagline “today’s research is tomorrow’s care” are present across the hospital buildings promoting our revised webpages and email and telephone contact details of who to discuss research activities and opportunities with, in addition to NIHR leaflets being available in all outpatients waiting rooms, reception areas and PALS. A research sign posting guide was also developed for staff use, outlining the top five places to whom an enquirer should be directed to for more information. This has been used as the basis for short training sessions with outpatient staff, receptionists, PALS officers and switchboard operators. It has also been printed and attached to all staff payslips to ensure blanket coverage, and inserted into Trust corporate inductions packs for new starters. The Research Nurse Forum members have been enlisted to further encourage use of the guide on the wards, and the junior doctor handbook amended to include the guide and emphasise the importance of research and the rights of patients to be given information about research opportunities available to them.

The crowning jewel of these efforts is the revised web pages, which direct visitors according to their needs (patients/public, researchers, and life science industry representatives). These pages contain a vast amount of information in a user-friendly and easily navigated format. All research studies currently open to recruitment are listed along with brief details and contact information. Increased appropriate participation in our research portfolio may result from these listings, but primarily this resource is acting as a unique and vital source of information for patients/public, and staff alike. Internally, a desk-top icon has been placed on every Trust computer (advertised through a research screensaver and email blast out) to enable staff to quickly identify whether the Trust does indeed have research opportunities that are potentially relevant to a particular patient.

We have now wound RAWG down, in favour of a new Research Information Group (RIG), aiming to capitalise on work already undertaken and to co-ordinate ongoing support to promote and raise awareness of research in the long-term. We aim to achieve this through regular updates of live initiatives, a more pro-active approach to publicising research successes and achievements as well as the development of benchmarks additional to the repeat of the local mystery shopper exercise to enable us to measure the impact of these initiatives. Which links in nicely with the new NIHR campaign: “Research changed my life”

Exclusive preview! UK clinical research gets its own TV show…..Downtown eat your heart out @NIHRCRN

So here’s something to make your crumpet and jam just a bit more palatable on Sunday afternoon…Thanks to NIR CRN.

This week Health Sector TV will be broadcasting a programme entitled ‘Clinical Research: Making Patients
and the NHS Better.

The blurb says that this is ‘an important new documentary highlighting how the Clinical Research Network (as part of the National Institute for Health Research) provides the infrastructure that allows high-quality clinical research to take place in the NHS, so that patients can benefit from new and better treatments, and we can learn how to improve NHS healthcare for the future.’

You can view the programme via Health Sector TV on Sky Channel 212 and Freesat Channel 401 on Sunday 20 October at 5.30pm and then it is repeated on Monday 21 October (5.30pm) and Saturday 26 October (12pm).  But you can view it now here!

As ever, the patients steal the show and my thanks to interviewees: Carole Bennett and Katrina Randle.  Also interviewed are:

  • Dr Jonathan Sheffield, CEO, NIHR Clinical Research Network
  • Lydia Christopher, Director for Industry, NIHR Clinical Research Network
  • James Calderwood, Research Nurse
  • me!

I believe you will also be able to view the film online at Health Sector  The film is also be available for healthcare professionals to view online for 12 months at anytime via Health Sector TV.

Building ‘research active’ communities for a healthier population: a clear mission for CLAHRCs, AHSNs, LCRNs

I am in Alberta, Canada.  I have been invited over to share the UK’s experiences in developing public involvement in research.  As ever, it is the similarities and not the differences between our two experiences that strike you on a visit like this. More about those another time.

My good friend, Derek Stewart, yesterday wrote an excellent blog with his thoughts on what we are trying to achieve through public involvement. He is right. Public involvement, participation, engagement, these are all a means to an end.

I wonder whether our real aspiration should be the development of ‘research active’ communities that lead to a healthier population.  On the 50 minute plane trip from Edmonton to Calgary yesterday I tried to draw/visualise what would define that ‘research active’ community with ‘healthier populations’ in the centre circle:

research active communities

Well, it is a rough sketch and I’m no Tony Hart.  This is what was flying by the window by the way:

Edmonton to Calgary

I very much believe that by community we could just as well be talking about an organisation as a neighbourhood or a patient population.  The term embraces all its citizens as well whether they be patients, carers, the public, researchers, clinicians, etc. etc.  Anyway, in a ‘research active’ community the following features would seem to me to be in the ascendant (this is what I wrote in the smaller, outer circles):

  • Research is visible to its members
  • Research priorities are defined collectively
  • Citizens help shape research design
  • There is learning through the communities’ experience of health and wellbeing
  • Citizens have clear opportunities to participate in research and are encouraged to do so
  • Research is central to the provision of health and social care
  • Its members are working in an equal and respectful partnership
  • Citizens can access and use research evidence as part of their care and treatment
  • Citizens share in the governance of research

Alberta is going through a process of rapid restructuring and re-organisation of research across the province.   It is not dissimilar to what is happening across the 15 local geographies in England where we are seeing Academic Health Science Networks (AHSNs), Collaborations for Applied Health and Research and Care (CLAHRCs), and Local Clinical Research Networks (LCRNS) occupy the same patch.

ahsns

Their collective mission is to work with their local NHS and other partners to build research and innovation into the way we deliver health and social care of patient benefit.  So, what happens between these new organisations will be more important than what happens within them.  Partnership, integration, connectivity will be the name of the game.

Similarly for public involvement a process of re-purposing within these areas must happen in my view.  We still have much to do to ensure public involvement is improved in research prioritisation, design and delivery.  But we must not become too introvert.  It will be important that we look out of our windows, work with patients, the public and our public involvement colleagues across the way, and build the connections that will grow communities that are active in research and healthier for it.