APPENDIX 4
Memorandum submitted by the British Association
for Cancer Research
1. INTRODUCTION
1.1 Cancer research comprises:
I basic studies on the molecular biology
and genetics of cells and on their organisation in the metazoan
body;
II strategic application of these and other
studies to the understanding of the causes and mechanisms of cancerous
growth and behaviour;
III translation of this understanding into
new methods to manage cancer in the population and in individual
patients and
IV clinical investigations to assess the
value of new interventions.
1.2 The British Association for Cancer Research
(BACR), with membership of 1,200, is the only UK professional
body that spans all these branches of cancer research. The views
expressed here are a distillation of those of Executive Committee
members and represent the breadth of BACR opinion. Because BACR
neither funds nor pursues its own research, we are not able to
support our views with quantitative data but we are uniquely able
to give a consensus opinion from active cancer researchers. BACR
exists primarily to promote research, not the interests of researchers,
but it recognises that these are closely linked in determining
the future of cancer research in the UK.
2. COMMENTARY
2.1 As the UK population ages and the management
of other degenerative diseases improves, cancer will become an
even more important cause of disease and death, a burden that
can only be eased by reducing cancer incidence and improving its
survival. Research has already revealed enough about the causes
of cancer to make better prevention largely (but not entirely)
a matter for political and societal will. Research has not yet
learned enough about the mechanisms of cancer development to affect
significantly the success of current treatments, which are improving
only slowly. The last decade has, however, seen major advances
in understanding the molecular bases of cancer, offering great
hope for improvement of existing treatments and the creation of
new therapies in the decades to come.
The adequacy of resources
2.2 Unlike the situation 20 years ago, there
is now more good work that needs to be done than there are funds
to support it. However, since the charity sector is unlikely to
engender large increases in income, major increments would need
to come from the Government, EU or industry. MRC supports basic
research and clinical trials but leaves most strategic and translational
research to the charities, whereas industry's support of these
latter two areas can be very focused on individual company's own
translational aspirations. Since strategic and translational research
together offer the best hopes for future improvements in cancer
management, they represent one target for additional resources.
2.3 Another target is represented by the
researchers themselves who, in common with other academic researchers,
have an inadequate career structure. Among laboratory researchers,
lack of job security and inadequate pay continue to depress morale
and drive individuals into other careers or, worse, abroad. For
clinical workers, research becomes increasingly hard to sustain
as they move up career ladders that provide greater pressures
(and rewards) to deliver clinical services, as articulated in
the Richards Report (1997). Both categories of researcher spend
inordinate amounts of effort in competing for, and accounting
for, research funding, whose conservative allocation encourages
"safe" research at the expense of innovative but high
risk studies. It is only the latter, however, that will lead to
the advances needed to keep our national research enterprise at
the international forefront. There is therefore a clear need for
a greater proportion of resources to be provided on a longer term
basis to both personnel and programmes.
The effectiveness of organisation and coordination
2.4 In view of the multiplicity of bodies
of differing ethos supporting cancer research, co-ordination is
remarkably good. The importance of co-ordination increases the
closer the research is to the patient and a major successful role
of the United Kingdom Co-ordinating Committee for Cancer Research
has been in clinical trials (although not all UKCCCR members participate
fully in this). UKCCCR has also served, in the past, as a liaison
body between academia, government and industry and it should continue
to fulfil these tasks.
Barriers to translating basic research into the
clinic
2.5 These are threefold.
I Many basic researchers are not keen to
become involved in translational research which has had a reputation
for lack of rigour.
II There are too few high calibre clinician
scientists who can impart the challenge of translational research
to their basic science colleagues. This shortage reflects, in
part, the overall dearth of oncology specialists, particularly
medical oncologists and in part the unattractiveness of an academic
clinical career (Richards Report, 1997).
III Most translational research is expensive
and likely to require an industrial partner before it can be tested
in the clinic, with the potential problems set out in paragraphs
2.8-2.10.
The number and distribution of centres of excellence
2.6 The cancer charities, in particular,
have been instrumental in establishing centres of cancer research
excellence throughout the UK and the reorganised structure of
cancer service provision is of help in this. Their distribution
is probably now approaching optimal and further resources would
be best spent in judicious strengthening of individual centres,
particularly to maximise their translational research potential.
2.7 Experience in other countries shows
that a comprehensive National Cancer Institute can be a very effective
instrument for research, particularly in its early years. It appears,
however, to work better in countries with a small area and dense
population, such as the Netherlands. Moreover, a centralised and
inevitably bureaucratic organisation can become relatively inefficient
(as in the United States) and the massive investment in infrastructure
can make it hard to effect necessary changes. There are already
sizeable cancer research institutes in the UK whose distribution
broadly reflects that of the population and hence of clinical
activity. We have no enthusiasm either for creating a major new
institute or for enlarging an existing one to "national"
status, preferring to use scarce resources to build on the diverse
strengths of existing centres.
Industrial investment issues
Industry's decisions to invest in development
and clinical trials depend on three major factors; time, cost
and the market post launch. The UK shows weaknesses in all three.
2.8 Pressure to move drugs quickly from
laboratory to market places a premium on the rapid performance
of high quality trials. Rate limiting ethical approval processes
(MREC, LREC) are seen by industry as slow, inconsistent and duplicative,
whilst hospital R & D committees are considered a further
hurdle (many academic strategic and translational researchers
also view these regulatory regimes as needlessly restrictive).
2.9 Industry would prefer a standardised
set of costs to be applied by hospitals and universities (again,
academic researchers are concerned that institutional overheads
can sometimes be excessive and thus diminish the support they
receive from industry). There is concern that the UK may price
itself out of the European market for industry-driven trials,
particularly in competition with Eastern Europe.
2.10 Companies tend to invest research in
countries where there is a market for a drug, once approved, enabling
further practical experience to be gained. If the UK cannot afford
to prescribe new safe and efficacious medicines (after appropriate
NICE procedures) it may not retain pharmaceutical industry research.
The suitability of NHS oncology centres for clinical
trials
2.11. Overall we consider this to be satisfactory,
largely through the support of many of these centres by cancer
charities. Staff could be more appropriately resourced and trained
and a greater application of NHS R & D funding may help to
raise the currently low status of research among clinical oncologists.
However, it should be noted that the views expressed in this paragraph
are those of researchers from other disciplines.
3. CONCLUSIONS
3.1 Existing structures for cancer research
in the UK have been very successful in delivering cost effective
yet high quality research, which compares very favourably with
the productivity in other countries. However, as cancer research
enters a phase of unparalleled progress, the UK effort is likely
to be impeded by factors that will lead to a relative decline
in its international status (paragraphs 2.3, 2.5, 2.8-2.11).
3.2 Significant new resources for cancer
research are only likely to come from government and industry
sources. Since such additional support will probably not be substantial,
it needs to be carefully targeted.
3.3 Additional government funds (Research
Councils, NHS and other channels) should assist in improving career
structures for both laboratory and clinical scientists and should
support, in particular, strategic and translational work (paragraphs
2.2, 2.3). Innovative, potentially high risk research, which is
essential to maintain the UK competitive position, should be fostered
by longer term support to scientists and centres with proven track
records. This would be more effective use of funds than the creation
of a National Cancer Institute (paragraphs 2.6, 2.7).
3.4 National successes in innovative strategic
and "proof of principle" research will help to attract
industrial investment. However, industry commitment to translational
and clinical research should also be encouraged by more efficient
regulatory regimes (paragraphs 2.8-2.10)
28 February 2000
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