APPENDIX 21
Memorandum submitted by the University
of Manchester, the Christie Hospital NHS Trust and the Paterson
Institute for Cancer Research
1. INTRODUCTION
Cancer research in Manchester is centred on the Christie
Hospital, the Paterson Institute for Cancer Research, and the
Victoria University of Manchester. The Hospital provides the largest
integrated cancer treatment centre in Western Europe. A number
of very strong research groups in basic cancer biology, and in
medical oncology, are based in the Paterson Institute and in the
University Medical School. The University expects to expand its
research portfolio in oncology by making a strong appointment
to a newly established Chair in Radiation Oncology.
2. THE NEED
FOR A
NATIONAL CANCER
INSTITUTE
We do not believe that the establishment of
a single National Cancer Institute would be the best use of the
resources available for cancer research. Rather, we favour further
development and consolidation of existing centres, and establishment
of new groups, interlinked to form a nationwide "virtual"
centre. Each grouping within this network should include a clinical
centre of adequate size, the associated research-based university,
and ideally a pre-existing cancer research institute, such as
the Paterson Institute or the Beatson Institute.
Priorities for support in this cancer research
network include:
(i) Career development of a cadre of research
workers of the highest quality. We commend the career development
programmes of bodies such as the Medical Research Council, The
Wellcome Trust and the Cancer Research Campaign. However, there
is not adequate funding for development of careers in cancer research,
and this should be highlighted as a national priority. A particular
factor in cancer research is the need for a limited number of
laboratory-based researchers to have a medical background, so
that they can bring the particular knowledge of the clinical and
pathophysiological features of cancer to research in the laboratory.
(ii) Facilities and equipment for research
are often unusually expensive—ranging from specialised cell
biology and molecular biology equipment (such as cell sorters,
DNA sequencers and the like) through to equipment for patient-oriented
research (including equipment for the various modalities of medical
imaging). We welcome the Government's recent initiative to provide
additional funding for equipment for cancer treatment, and this
should be complemented by additional funding for cancer research
equipment.
(iii) One of the biggest challenges in cancer
research is to ensure that the great advances made in the molecular
and cellular understanding of cancer are developed into new methods
of diagnosis and treatment. Such translational research requires
additional financial support and is most likely to succeed in
groupings where cutting-edge basic and clinical research are juxtaposed.
This is a long-term and complex field: therefore, secure funding
over a period of many years is required to build up teams with
appropriate expertise to test new treatments. Whilst the UK has
had an excellent track record, there is a danger that with increasingly
complex treatment, the funding is inadequate to sustain this.
(iv) Support for clinical trials is, at present,
unsatisfactory. The UK currently manages to perform a large number
of small scale, high quality trials through the Cancer Research
Campaign but there is really no other research organisation which
supports such early phase trials. In the larger scale clinical
trials, charitable funding is inadequate for the large costs involved,
particularly where drug costs are significant. This requires a
major input from the NHS R&D programme. It is dangerous to
be almost entirely reliant on pharmaceutical funding for this
type of trial, as important health economic issues will often
fail to be addressed.
It is a matter of grave concern that in recent
years, many of the large scale national trials in the UK have
been greatly delayed and become merely confirmatory trials. As
a consequence, they have not been held in high international regard.
This delay is not because of lack of clinical commitment but because
of excessive bureaucracy and insufficient funding.
The National Institute for Clinical Excellence
should be involved in the strategic programme of clinical trials
research in cancer. The aim is to produce objective evidence of
the efficacy and cost-benefit of new treatments, and introduce
them into clinical practice. The question of the balance between
expenditure from the public purse on new cancer treatments, and
other calls on health service funds for treatment in other diseases,
should be a matter of open, public debate.
3. SOURCES OF
FUNDING
Official support for cancer research comes at
the interface between the Research Councils, mainly the Medical
Research Council, and the Department of Health. The precise source
of funds matters less than the overall level of support that is
available. Some activities, notably clinical trials (above) are
a legitimate call on the Department of Health's R&D budget.
It is of crucial importance that, as a nation,
we cease to rely as much as at present on charitable funds. The
public is not aware of the low level of official funding available
for cancer research, a position that can only be sustained by
virtue of the generosity of the public in their support of cancer
research charities. Such charitable funding is of a precarious
nature, and should not be relied on to be the spearhead of our
national effort.
It is also important that additional funding
be available for routine clinical practice. This should be directed
to cancer centres because they are able to provide continuing
data on the use of new treatments. Currently, as there is not
sufficient funding for new therapies it is likely that the UK
will increasingly be seen as a backwater for pharmaceutical companies—in
the future they may not even bother to do clinical research here.
There is some evidence that this is beginning to happen already
and it is a trend that needs to be reversed urgently.
4. We commend to the Select Committee the
United States National Cancer Institute (http://www.nci.nih.gov/).
The Committee should note, in particular, the scale of the National
Cancer Institute's budget in relation to total government expenditure
in the United States. The comparison with the United Kingdom is
highly unfavourable. We also particularly recommend the way in
which the NCI has provided a strategic overview of cancer research
for the United States of America, and the vision set out in this
overview deserves the Committee's attention.
5. CONCLUSION
As a nation, we have great strengths in cancer
research, and many notable advances have been made in British
laboratories, research institutes and hospitals. However, much
more could have been done, and will be done, with a better-coordinated
and better-funded national strategy.
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