Seeing the difference a clinical trial drug can make to a patient reaffirmed the reason why I wanted to be a clinical research nurse - Elaine Blowers

Elaine Blowers, former divisional lead research nurse at The Christie

Elaine Blowers (left)

Before her recent retirement, The Christie’s most senior research nurse and operational director for the National Institute for Health Research (NIHR) Manchester Clinical Research Facility (CRF) at The Christie, Elaine Blowers, shared some of her proudest moments, the key developments she’s seen in experimental research during her career, her reasons for getting involved in research nursing and her hopes for the future.

Looking back, my initial interest in clinical trials came when I was a student nurse in Birmingham and participated as a healthy volunteer in early phase clinical trials of cardiac drugs. I recall being intensely monitored all day long and was given a fried breakfast to test the effects of the drug with a fatty diet - I got paid too which helped me with my rent!

I qualified as a registered nurse at the Queen Elizabeth hospital in Birmingham in 1986 and worked in a number of roles such as coronary care and acute medicine before moving hospitals and working in oncology at the Dudley Road hospital in Handsworth, Birmingham. From there I pursued my interest in oncology and started my science degree at the Royal Marsden, working at both the Fulham Road and Sutton sites. I went on to work at Mount Vernon regional cancer centre as a senior nurse manager in oncology before moving to St Mary’s in Paddington to a take up a clinical nurse specialist post in breast cancer. 

I became a Macmillan nurse specialist for Mount Vernon and Watford General hospital before moving to the North West in 2000 where I worked for Healthcare at Home Ltd, delivering chemotherapy and long term treatments in patient’s homes and clinics in the North West. Through this role, I became involved in a clinical research trial being conducted at The Christie where part of the trial involved delivering treatment in patient’s homes as one of the trial arms for breast cancer patients. 

I was approached by the breast cancer research team to apply for a research nurse post and was successful. As a breast cancer research nurse, I was part of a team that became one of the most successful breast cancer research teams in the UK and I was one of two first nurse advisors for the breast ncri clinical studies group. I became the breast research nurse team leader in 2007. In 2014, I was appointed as the operational director for the NIHR/CRUK CRF at The Christie and divisional lead research nurse.

The NIHR is the part of the NHS that helps to fund clinical research, and the Clinical Research Facility at The Christie is one of four centres in Manchester that have joined together to provide integrated health research across Greater Manchester.

I’m very proud to have had the opportunity to work at The Christie. As a specialist centre, all staff are committed to ensuring patients and their families have the best possible experience and care. Staff are proud to work here and care for each other; they continually look for opportunities for innovation and are supported in making change for patients’ benefit. Walking through the hospital, people acknowledge each other and it normally takes me quite a few minutes to get to my office in the morning as I talk to staff and patients along the way.

Patients at The Christie are always pleased that they have been given the opportunity to participate in a clinical trial as one of their treatment options. They feel special and confident being cared for in a dedicated research centre with highly trained research staff and receiving the best care. They hope that the trial will make a difference to their health, although they also understand that it is a trial and therefore may not benefit them directly but they are pleased to be able to make a difference for their own and their children’s future and are aware that it’s only through trials that we learn if a new treatment is better than the current best treatment we have available.

I am thrilled to have been fortunate enough to be involved in a number of breast cancer trials where drugs from an early phase trial have gone on to become standard care for patients, for example, Herceptin, Perjeta and Lapatinib. This is not a daily occurrence, as only a small number of drugs are both clinically more effective and also pass through all the safety phases before being licensed for standard care delivery.

One of the major breakthroughs I was involved with back in 2003/2004, which was unprecedented, was when early results indicated that Herceptin improved outcomes for early breast cancer. It was a very rewarding experience and reaffirmed the reason why I wanted to be a clinical research nurse - to make a difference to patients’ outcomes.

Since 2017 when NIHR/CRUK Christie CRF , NIHR/Wellcome Trust Manchester CRF  and NIHR South Manchester Respiratory and Allergy CRF  came together to form the NIHR Manchester CRF, I have played a key role in driving the successful integration of the Manchester CRF. This collaborative bid for NIHR funding, which brought the previous CRFs in Manchester together under one single management structure, has helped to create the largest (and hopefully most influential) NIHR CRF in the UK.

I was also delighted to have helped organise the UKCRF annual conference in Manchester in 2016. The conference was the first time that the Manchester CRFs came together to work collaboratively before the formal bid to become one Manchester CRF. I played a key role in winning the open competition to host it in Manchester along with Professor Andrew Wardley.

Looking back, I’ve seen a lot of changes over the years. There has been an increase in the complexity of delivering experimental cancer medicine trials and the science behind them since I started. And whilst the increasing number of trials for personalised medicine and targeted treatments is wonderful for the patients who are eligible, it brings its own challenges of screening large volumes of patients to find the right patient with an identified mutation and then to receive the appropriate treatment for this in the context of a trial. 

I’ve also seen a big increase in digitalisation at a number of levels in clinical research, from using IT to set up and conduct clinical trials to the use of IT devices by patients to inform decisions whilst participating in experimental cancer medicine trials.

One of the most rewarding changes has been that clinical research nursing has been recognised as a speciality in nursing in its own right – and now has its own clinical research nursing strategy.

I‘m really going to miss the wonderful staff that I have had the privilege to work with over many years - especially the clinical research nurses who demonstrate such commitment and passion for this very specialised complex area of nursing on a daily basis.

Looking ahead, I’m leaving behind an amazing team. The redesign and reconfiguration of the Manchester CRF facilities at The Christie in 2017/18 have ensured that patients now have a dedicated reception area and there is a big increase in space for experimental trial delivery. Thousands of patients will benefit from this fantastic facility in future years.

Moreover, I hope that a growing number of patients will have access to experimental cancer medicine trials and to clinical trials closer to their home.

I also hope that the NIHR Manchester CRF will go from strength to strength and continue to be the most successful and largest CRF in the UK, in addition to receiving growing international recognition for the superb work being done.

It’s been a privilege to work at The Christie and to help so many fantastic and inspiring patients.

Patients can learn more about clinical trials at www.christie.nhs.uk/professionals/research/clinical-trials/taking-part-in-clinical-trials/

Why it’s so important to talk about genomics

Fiona Blackhall

Fiona Blackhall - Manchester Cancer clinical director of genomics and honorary consultant in medical oncology at The Christie

Earlier this month, Health Education England, through the Genomics Education Programme, launched its second annual #GenomicsConversation week.

Here in Greater Manchester, we are pledging to continue the conversation by ensuring that we work together to embed genomic medicine into our cancer pathways. It is vitally important that our whole clinical community are able to talk to patients and their family about the growing role of genomics in treatment.

Greater Manchester Cancer (our cancer alliance) has pledged their support, in our GM Cancer Plan for 2017-2021. One of the ways they are doing this is by developing a Genomic Pathway Board which will lead the adoption of genomic medicine in cancer pathways across Manchester. The board will comprise of experts from pathology, oncology, research and the Manchester Genomic Centre.

The aim is to:

-        Create road maps for clinical staff to follow with standardised procedures (from requesting a sample to delivering the report to the patient)

-        Create educational tools for patients and clinical staff to raise awareness and increase understanding of genomic testing and how it can improve outcomes for patients

-        Work to ensure all patients across Greater Manchester have equitable access to genomic testing

Following on from the incredible work of the 100,000 Genome Project, which proved that genomic testing can work in a routine clinical setting, we will work together to embed this into routine care for our patients.

The 100,000 Genome Project laid the foundations for an NHS Genomic Medicine Service which is currently being rolled out across the entire NHS. Within Greater Manchester, we will use the learnings from trials such as the 100,000 Genomes Project to bring genomic testing to the forefront of routine clinical care for our patients.

Genomic testing can help us to change the way we treat cancer by providing a more detailed diagnosis and personalising treatment for patients.

As a clinical community, working in cancer across the whole of Greater Manchester, we pledge to ensure that we utilise the potential of genomic technology to improve the health of our population.

Protons coming home to Manchester - Hazel Pennington

Hazel Pennington, The Christie

Hazel Pennington

I wasn’t around when Ernest Rutherford first discovered protons at Manchester University in the early twentieth century. However, 100 years later I have the privilege and amazing opportunity to be involved in developing the first UK NHS high energy national proton service at The Christie in Manchester.

My journey started in 2014 as the lead radiographer in the project. In fact, I was the only radiographer for a few years. This may have been viewed as a challenge in a profession where we usually work in radiographic teams, but I thrived on the opportunity to work closely with other professions. 

Initially, I worked with the clinical lead, a consultant clinical oncologist, the head of physics and the lead engineer. We all got to know each well after many hours spent together in meetings, on trains to London, on long-haul flights to conferences and overseas hospitals, and evenings out in a new city talking about what we had seen and learnt that day about protons and our vision for the future. Unbelievably, we all still get along!

As well as my clinical and physics tag team, I worked with project managers, lawyers and the finance department to acquire the proton equipment. Proton equipment procurement has a reputation for litigation, and for some countries, legal challenges have significantly delayed their progress. The team worked hard to ensure a smooth process and to avoid legal challenges. The learning curve was huge and I was often in overdrive: not only were protons new to me, but the project processes were also new.

Next to learn about were concrete and cranes! Who would have thought as a student radiographer that 25 years later I would be discussing the logistics of the crane size needed to get an 90-tonne cyclotron (the bit of equipment that generates the actual protons) into place and how we needed part of the external wall removing on the first floor to get the MRI scanner into place as it was too large for the corridors. I now know what a ‘crane oversailing license’ is (a license allowing a tower crane to oversail property adjoining the site) and that a ‘joggle joint’ ensures each concrete element locks together securely to prevent radiation leakage at stop ends. I spent many an hour with architects, engineers, the construction team and designers.

Did I lose sight of the patient in all this project work, I hear you ask? I hope not. I created a patient representative group of patients, from children to octogenarians and their carers, who had received proton therapy overseas. They blew me away. I can’t find the words to describe how incredible they were. They gave up their free time to explain what it was like being away from home for a couple of months for treatment, the best type of accommodation, how to keep up with school work, ideas for how the centre should feel and look, and the best types of patient information. 

We took all this vital information on board and have hopefully created a patient-centred service, which includes every patient having a named key worker (specialist nurse or radiographer) who telephones patients before they arrive for their first appointment (talking was the best type of patient information). 

Only this week, I was gratified to hear that one of our five-year-old proton patients on his first visit said the centre was the ‘best place ever’ and he couldn’t wait to come back next week to show his mum. Ultimately, everything we do as healthcare professionals should be about the patient.

How do I feel now the service is operational? Exhausted! 

Seriously, first and foremost I am immensely proud of everyone who worked tirelessly to start the service. The success of the project has been down to the hard work and collaborative working of the whole team. It is one of the aspects of the project, and now operational service, that I enjoy the most. We have a close team, not only of radiographers, physicists and doctors but of nurses, theatre practitioners, anaesthetists, support workers, secretaries, play specialists, allied health professionals, social workers, MDT co-coordinators, complementary therapists, governance officers and domestic staff. 

They are all, without exception, brilliant. I have a huge amount of knowledge and respect for the other professions. I’ve learnt a lot from my co-workers and I take great pride in calling them, my colleagues.

The ‘C’ Word - Richard Jackson

Richard Jackson, Christie cancer survivor

Richard Jackson

There are some words that are always hard to hear, let alone say, but for many of us, living with cancer is a reality we can’t avoid. Conversations with the ‘C’ word are inevitable.

When I was diagnosed with stage 4 malignant melanoma (a type of skin cancer) I was offered the opportunity to join a clinical trial at The Christie. There were no other alternatives to treat my cancer at this advanced stage, so it wasn’t a difficult choice to make. If the trial wasn’t going to benefit me, perhaps some of the findings would help to develop more effective treatments in the future.

My initial trial was unsuccessful, the treatment I was taking had reduced the swelling in my lymph nodes in my neck, however the tumours around my body, just under my skin, were growing both in size and number.

The next conversation I had with the specialist registrar was probably the hardest I’ve ever had to have. The bare facts were presented to me and as far as he could see there was nothing else that could possibly be done. In his words, “It was time to face my own mortality.”

What is amazing about being a Christie patient is the fact that the doctors, nurses and other support staff don’t give up easily. They gave me the hope to try and face my future and find other options that might be beneficial. I was still strong physically and prepared to consider whatever could help me remain an active part of my wife and young family’s lives for as long as possible.

The chance to use a new style of cancer treatment was offered to me, an immunotherapy drug. It had been on trial at The Christie, but I was allowed access to it as a therapy. I really needed to have the comfort that I had tried everything so I jumped at the chance to trial the new drug.

Incredibly, within 24 hours of my first treatment, my tumours had reacted and changed. They were no longer dark and sinister but had changed to a flushed red.

My wife is still convinced she watched a large tumour in my neck slowly reduce as we sat watching a film. Not wanting to get carried away, we visited my consultant, I remember explaining what we could see, and saying, ‘I don’t want to get too excited, but…’

The response, once the evidence of my tumours reducing was obvious to my consultant, is one I’ll never forget: “Let’s all get very excited.”

Five cycles of treatment later, and after enduring some unpleasant side effects, I was clear of cancer. The last of my treatments was on my 40th birthday, in 2008. This year I celebrated my 50th birthday with my family, 10 years cancer free and living a normal life.

Thanks to The Christie, the ‘C’ word I can use now with confidence isn’t cancer, it’s cured.

 

Christmas at The Christie - Michael Seaton

Michael Seaton, Christie patient

Michael Seaton

In December 2013 I was diagnosed with late stage 2 non-seminoma testicular cancer and bizarrely I was not surprised.

 

I had an obvious lump, but I had never mentioned this to my GP, mainly due to embarrassment and worrying about having to take time off work - both fairly stupid reasons with hindsight.

 

What I had told him about were some of my other symptoms, like shortness of breath, sudden weight loss, abdominal pain not unlike irritable bowel syndrome, difficulty keeping food down and what seemed like a kidney stone.

 

I had tried various medications to tackle these with varying degrees of success. My GP eventually referred me to the gastroenterology unit at Macclesfield District General Hospital, for a double endoscopy/colonoscopy session, something I was not looking forward to. 

 

Fortunately, someone at Macclesfield had the bright idea of putting me through a CT scanner. I presumably ‘lit up like fairy lights on a Christmas tree’, judging by the phone calls I had later that day in quick succession to cancel the endoscopy/colonoscopy (phew!) and arrange an appointment with a urologist to sort out an orchidectomy.

 

Eight days later, I was on the operating table at Stepping Hill hospital to have the primary tumour and my left testicle removed. The original plan was for me to go home the following day and recover over Christmas before starting chemotherapy in the New Year.

 

Unfortunately, my secondary tumours had other ideas. What should have been an overnight stay turned into four days with infections making me rather unwell and not fit to return home. One of the tumours was partially blocking my left kidney, which meant having a nephrostomy (a narrow tube) inserted into my side to help drain it. The stoma bag surrounding the tube needed replacing every couple of days or so, which meant this was the bane of my existence for six months! The antibiotics I received to deal with the infections also gave me candida (oral thrush), which made eating quite difficult.

 

Clearly I was not doing very well and a decision was made that my chemotherapy could not wait until 2014 and I had to have some as soon as possible. So on a wet and chilly Monday morning, I was put into a wheelchair and bundled into an ambulance. About twenty minutes later, I was helped into The Christie, which (as it turned out) would be as near to a second home as I would get for the following four months or so.

 

I was going to receive a three-day course of some EP (cisplatin and etoposide) chemotherapy to start attacking the troublesome secondary tumours. This would be a stopgap before I started the main 5-day BEP (bleomycin, etoposide, and cisplatin) regimen in mid-January.

 

So far so good, but there was one problem! The first day of this three-day EP course would be 24^th December. I therefore had to stay in The Christie for Christmas Eve, Christmas Day and Boxing Day … no family Christmas at home for me in 2013.

 

Whilst being in hospital over Christmas is clearly nobody’s first choice, it was actually not so bad an experience. All of the people working at The Christie – the nurses, the cleaners, the doctors – were very nice and sympathetic, helping me through the chemotherapy itself and various other treatments beforehand and afterwards. Even while I was hooked up to my chemotherapy drugs on Christmas Day, everyone there helped cheer me up. Not only did I get a turkey dinner (even though the candida meant I was unable to eat very much of it), I was also given some shower gel and deodorant as an additional Christmas present. Being hooked up to a drip machine for most of my visit meant I could hardly use them while I was there, but it was the thought that counted.

 

The normally quite liberal visiting hours – 12 noon to 8pm each day apart from protected mealtimes – were also extended to essentially 24 hours during the Christmas period to make it easier for people from further away to visit. This was an absolute godsend for my family – some of whom had come from as far afield as Lancaster, Suffolk and Dubai – and it meant that they could visit me at least twice a day to keep me company. I later learned that my family were understandably not in the mood for a full Christmas dinner on the big day itself, which they postponed in favour of a stir-fry!

 

Like a lot of people from my generation, I rely on being connected to the Internet for entertainment and keeping in touch with people, which is why The Christie’s free wifi was so useful while I was stuck in bed. I only had my trusty iPhone and a charger with me – I had not intended to be in the hospital for quite so long, so I had not brought in my laptop – but this was enough to keep up with emails when I could concentrate, and to play games when I couldn’t.

 

The EP chemotherapy did indeed help improve things. The abdominal pains almost completely stopped and, when I could actually eat, I was able to keep my food down. I still had to stay an extra five days to deal with some residual stuff, such as a blood transfusion to help boost my iron levels, filgrastim injections to try and boost my white blood cell count and waiting for a rash on my back to clear caused by a newly-discovered allergy to allopurinol. After all of that, I was finally discharged on New Year’s Eve and I saw 2014 start at home with my family.

 

Unfortunately, my next visit to The Christie was considerably sooner than I expected. I had to be readmitted about 24 hours after I had left due to an infection while still neutropenic, possibly because the top of an impacted wisdom tooth had broken off (I had visited an emergency dentist and an out-of-hours GP, all to no avail).

 

This time around, I had to be put into a side-room in one of the wards to prevent infecting other vulnerable patients and be attached to an antibiotic drip. Fortunately, the antibiotics managed to work well enough to allow my white blood cell count to recover and I was able to return home a week later. This coincided with my birthday, so being allowed to go home again was the best birthday present I could have wished for!

 

The rest of my 5-day BEP chemotherapy sessions were less fraught than the EP cycle I had at Christmas. I was better prepared for my four 21-day cycles. Not only could friends finally come to visit whenever I was there, I was also able to bring in my laptop to give me something to do while the drugs were being put through me. I work as a computational scientist for one of the UK’s research councils, so I was able to do a little bit of programming and catch up on reading research articles while receiving chemotherapy as an in-patient. The candida also cleared up thanks to mouthwashes, so I could actually eat the various meals available. Fish and chips on Friday lunchtimes were my favourite.

 

Annoyingly, I gained some kind of infection each time I was neutropenic and had to return to The Christie (always on Day 10 of each cycle) to be given antibiotics and allow my immune system to recover. I reckon I must have visited every single ward and most of the side-rooms in The Christie! My hair also fell out, so I had to start wearing hats to keep my head warm.

 

More positively, I met quite a few other patients being treated for various forms of cancer, including someone else who lived in my hometown. The doctors and nurses were as nice and helpful as they had been at Christmas, telling me how well the chemotherapy was working (very well indeed) and helping me deal with its various side-effects. I had my last top-up of bleomycin in early April 2014 and since then I have only had to come in as an outpatient for scans and check-ups, as well as removing the nephrostomy (hurrah!). My cancer has not returned since the end of my treatment and I am almost certainly in remission.

 

That memorable Christmas has made me more grateful of how hard doctors and nurses at hospitals like The Christie work, especially when most people are having a peaceful time with their families (as I certainly will be this year).

My experience of having breast cancer has been an education in patience, humility and gratitude

Victoria Lavin

I'm an oncologist at The Christie. In August 2017, during the last month of my maternity leave, I was diagnosed with breast cancer. My experience of being on the other side of the consultation desk will shape my future career and it has helped me to understand what goes on for patients. It has been an education in patience, humility and gratitude.

I learned that cancer is not a battle, hair loss does matter, and even doctors like me can’t prepare for the effects of chemotherapy.

Initially, I was plagued by memories of the patients I had discharged home or to the hospice for end-of-life care. Thankfully they are few – but they are the ones I remember.

First, there were the well-meaning stock phrases which I myself had so often used as a doctor:

“You’re so brave; you can fight this”. Really? Yesterday I was a 34-year-old clinical oncology trainee and mum of two, and today I’m a professional cancer warrior? Cancer didn’t feel like a fight to me and I won’t be asking my patients to go into battle in future.

I have prescribed countless cycles of chemotherapy throughout my career, but still, there were some surprises. For example, intravenous dexamethasone given for nausea makes your bottom tingle when administered. Subcutaneous filgrastim to boost white cell production stings if you give it straight from the fridge.

The biggest ego-bruising revelation was learning who makes the difference. As the doctor prescribing the treatment I always felt my role was the most crucial. For the patient, however, it’s the healthcare assistant who smiles when you walk in and gets you seen on time; the volunteer who brings you a cup of tea; the complementary therapist who offers reflexology and a chat during treatment; and the nurse who gets the cannula in at the first attempt.

Embracing the new world of turban tying helped me to feel confident with my radically different appearance

I had never visited the Maggie’s centre at The Christie as a doctor, but soon discovered a welcome haven for myself, my friends and family away from the bustle of the hospital.

Hair loss is something we often gloss over in busy clinics. I have been guilty of simply handing over a wig leaflet as the patient walks out of the door. It matters. It changes a person’s whole identity. I worried what my children would think and that it made me look like a victim. In the end, my daughter said: “Mummy, you’ve got no hair like Grandad Pete” and carried on making her Disney princess puzzle. For me, a recommendation from a colleague for a local hijab stylist was a game-changer. Embracing the new world of turban tying and styling helped me to feel confident with my radically different appearance, look less like Grandad Pete and keep that victim behind closed doors.

It was no surprise that chemotherapy was gruelling. The first part of the treatment was predictable, but it was tough trying to fit housework, spending time with family and friends and exercising into the three days I felt well.

The second half of the process was a treatment affectionately known as the ‘red devil’ among cancer bloggers. Four hours after the infusion I felt an overwhelming need to lie down and sleep. Such extreme tiredness that brings you to tears is something I hadn’t experienced before. Giving patients permission to be kind to themselves in the first few days after treatment and not expecting to function anywhere near normally is something I will take back to the clinic.

There was just time after the final cycle to recover and begin preparing for surgery. Finding out that post-surgery bras are VAT exempt felt like a considerate concession from the government and high street retailers – and another tip to pass on to patients.

After surgery, I was very pleased to receive a physiotherapy leaflet in my pre-operative assessment and an invitation to a group session to ensure that arm movement was maintained. With scarring, the arm can become stiff. There was no way I was going to be that patient who couldn’t get their arm above their head and into the treatment position for radiotherapy. Thankfully the militant physiotherapy paid off and my radiotherapy planning scan went without a hitch.

I have heard the end of treatment bells ringing out in the department over the last three years and I have sometimes offered a clap or cheer if I was passing. As I rang the end of treatment bell for myself, I appreciated what it is to do so. The concept of the bell is a fantastic innovation, brought back to the UK from the USA by a family who had been there for proton beam therapy treatment and set up their own charity. The bell helps many patients mark the end of their gruelling chemotherapy and radiotherapy treatments.

For me, the bell also marked the start of my transition from being a patient back to being a doctor. As a result of my experiences I hope I can appreciate more what patients go through and understand what a difference all the dedicated and caring members of the NHS machine make to the patient experience, despite all the pressures they face.

Victoria Lavin is a clinical oncology trainee working at The Christie. She tweets @vjplested

We have demonstrated that modern radiotherapy is safe and effective in carefully selected older patients with small-cell lung cancer

Professor Corinne Faivre-Finn

It’s been an exciting few months recently as my colleagues and I at The Christie, collaborating with researchers throughout the world, have made some important discoveries relating to the treatment of older patients with small-cell lung cancer.

Small-cell lung cancer is a type of cancer that we diagnose in around 13% of all people with lung cancer. This type of cancer tends to spread quite quickly and many of our patients are diagnosed at an advanced stage. Unfortunately, despite a lot of advances in the field, survival rates have not significantly improved. To address this challenge, my team and I at The Christie have been doing research aiming to find better treatment options for these patients.

This week, The Journal of Thoracic Oncology has published the age analysis of the CONVERT trial which specifically looks at the outcomes of older patients in the trial compared to those of younger patients.

The CONVERT trial was an international clinical trial in which 547 patients with small-cell lung cancer that had not spread outside the chest, received radiotherapy delivered either twice-daily over three weeks (standard treatment) or once-daily at a higher dose over six and a half weeks (experimental treatment). All participating patients received standard chemotherapy together with radiotherapy.

The trial recruited patients from the UK, France, Spain, Belgium, Poland, Slovenia, Canada and the Netherlands and closed in November 2013. We have been analysing the results ever since and the publication this week is a very important step forward in our knowledge of the disease and the best way to treat it.

The results showed similar survival times and side effects from treatment in both radiotherapy groups. However, these results were much more favourable compared to previous studies that did not use modern radiotherapy techniques. We concluded that twice-daily radiotherapy should remain the standard treatment, but once-daily treatment could be offered in cases where twice-daily radiotherapy is not available or where there are logistical challenges.

A large proportion of the patients we see in our clinics are over the age of 70. Unfortunately, there isn’t a lot of robust information coming out of clinical trials regarding which treatment options are safe and effective in older patients. In the past, patients above the age of 70 or 75 have typically been excluded from clinical trials. This was mainly because of strict criteria excluding patients with a number of additional medical conditions or those on a lot of medications. The lack of information makes it more difficult for both the patients and their doctors to reach the best possible treatment decisions. With this in mind, we looked at the outcomes of patients that were 70 years old and above, who participated in CONVERT, and compared them to those of patients younger than 70.

My colleague Dr Marianna Christodoulou has been instrumental in analysing these results. Her work identified that out of 490 patients in total, 67 were 70 years old and above. The results in this age group were very promising, demonstrating similar survival times and side effects from treatment between the older and younger groups. Encouragingly, the proportion of patients in the older group that had life-threatening infections, needed to stay in hospital or have blood transfusions was not significantly higher compared to those in the younger group.

The CONVERT trial is the largest randomised trial to date investigating treatment combining modern radiotherapy and chemotherapy in patients with small-cell lung cancer that has not spread outside the chest. Being able to demonstrate that these treatment options are possible, safe and effective in older patients in the context of this trial will influence clinical practice, and benefit older patients with this disease in the future.

Perhaps the most important take-home message of this analysis should be that selecting patients for such intense treatments should be very careful. In this study, most patients in the older group who tolerated treatment did not have any other significant medical conditions or restrictions on their daily activities. In patients who are less fit, more information is needed as to which treatment options are best and firm conclusions cannot be drawn at the moment. Furthermore, only three patients in CONVERT were above the age of 80, preventing us from making treatment recommendations for this group. The design of more clinical trials that specifically look at the outcomes of older patients will be an important step for further research.

Dr Christodoulou and I are very pleased with the results of the study and the interest shown amongst the lung cancer research community. We would like to thank everyone involved in the CONVERT trial for their tireless, hard work and dedication.

Dr Christodoulou presented this work in 2016 at the 17th World Conference on Lung Cancer and won the Heine Hansen Lectureship Award. This was a fantastic tribute in recognition of the hard work the CONVERT trial team has put into this large collaborative project.

The study was funded by Cancer Research UK and was developed with, set-up and co-ordinated by the Manchester Academic Health Science Centre Clinical Trials Unit.

Visit www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-to-find-the-best-way-to-give-radiotherapy-for-people-with-small-cell-lung-cancer for more information about the CONVERT trial and visit www.christie.nhs.uk/professionals/research/clinical-trials/for information about clinical trials at The Christie.

We have worked hard to take our Outpatients department from ‘Good’ to ‘Outstanding’ but this is just the beginning - Olivia Samuel

Olivia Samuel, lead operational nurse

Last Friday, The Christie heard that we had been rated as an Outstanding trust by the health regulator, The Care Quality Commission (CQC).In amongst this detailed report, we found out that the outpatient service had improved from Good on a previous inspection to Outstanding this time, I was absolutely delighted with this both personally and for my team.

It is a true reflection of how dedicated our staff are at providing outstanding care to our outpatients every day. The outpatient team has worked hard and has consistently tried to improve services since the previous inspection in 2016 when it was rated Good.

Over the past year, we have worked diligently as a team to be the best we can be and try to lead the way in outstanding, compassionate care. We are particularly proud that the CQC found the outpatient service to be very responsive to patients and well-led, giving these areas of focus the highest possible Outstanding rating. These are both areas that have undergone some of the biggest changes. .

As a team, we were proud to showcase the work we have been doing with patients to improve the services in the department and gain their feedback for opening our new unit. We also had the opportunity to show inspectors our exciting new facilities that will open shortly.

My personal passion for outpatients came following treatment that I received from this hospital in 2016 for breast cancer. I had worked in the hospital for 12 years within the inpatient setting and until this point had been unaware of the extent of the activity that happens in the outpatient setting. 

As I stepped into the hospital as a patient, I was surprised and overwhelmed at how scared I felt. How could I feel so lost in a place where I knew my way around and knew so many people? How could I be so scared of the treatments and symptoms that I regularly reassured people about? My amazing colleagues wrapped their arms around me and carried me through it all, but not because I was a colleague, it was because they cared and wanted to do this for every patient. Compassion and care are embedded in all the staff.

My family liked to joke that I was given cancer to be The Christie hospital’s ‘secret shopper’, just a very extreme experiment to evaluate the service! But this was actually a good coping strategy and when the matron role became vacant in outpatients, it became the perfect opportunity to turn the extreme experiment into positive action. I could use my experience of visiting six different hospitals and over 30 different departments to lead The Christie’s busy outpatients department and help to improve it from Good to Outstanding.

As a department, we felt very determined to prove to the CQC how we believed the department had improved.

For me, outpatients became one of the most important parts of the hospital, the place where I received the most significant news throughout my treatments. The place where I can still remember word for word what people said, the expressions they used, the rooms I sat waiting in and the thoughts that all those things provoked. Outpatients’ is the place that provides the first impression of the amazing care that is given, it’s the place that trust is built upon, and the place where we need to get it right every time, for every patient, to make a horrible time easier for our patients.

Thank you and well done to everyone  who has helped us achieve this outstanding rating, including the valuable feedback from our patients.

You can read more about the ongoing redevelopment of the outpatients department at www.christie.nhs.uk/about-us/our-future/our-developments/our-new-outpatients/

 

April 2013 vs April 2018 - Nicola Stewart

Nicola Stewart - Christie fundraiser

In April 2013, I was in a bit of a mess. I was six months pregnant with our third child, Eliza, my husband and I should have been shopping blissfully for baby grows and painting the nursery with the same ecstatic excitement we’d felt when I was carrying James and Maisie, then five and two years old.

However, our third pregnancy had been spoilt in a way we could never have imagined, not even in our worst of nightmares.

In the previous month, I had been told I had cervical cancer. I had cervical cancer and I was pregnant.

I had had undiagnosed vaginal bleeding since the very early days of my pregnancy. We had rushed down to the Early Pregnancy Unit at the local hospital terrified that we were miscarrying this tiny life, who was barely days old. Ultrasound scans on a weekly basis for the first 12 weeks provided relief each week as our third child grew and seemed to be completely oblivious to all the anxiety we were experiencing.

Since a clear smear test 18 months previously, medical staff dismissed cervical cancer as a cause for the bleeds. We were told that “sometimes women just bleed in pregnancy”. Then, when I was around 24 weeks pregnant, another bleed occurred, and I sought reassurance that our baby was ok through a visit to the ante-natal unit. Hearing a heartbeat put our minds at rest. Following what had become a routine internal examination, a doctor I’d never seen before said it looked like I had a polyp and took a sample from my cervix.

Within a couple of days, I was asked to come back to see a doctor. Honestly, I thought it was simply an appointment to prescribe some iron tablets, so I sent my husband off to work. Fortunately, my parents said they’d attend with me, otherwise I would have been there alone apart from Maisie who was sat in her pushchair. It was at that moment I was given the news that turned our whole world upside down. I had cervical cancer.

Like any newly diagnosed cancer patient, I underwent examinations and scans, to determine how big the cancer was and what the most effective treatment was going to be. Though, unlike most other cancer patients, my scans were also studied to assess when they could safely deliver my unborn child, who we now knew was a girl. It was a balance of giving me the best chance of curative treatment in time and ensuring that Eliza had the best prospect of survival.

At this point I was told I would be treated at The Christie. The name of the hospital sent ripples of fear through me. The Christie? But that’s where ill people have to go…while I didn’t feel ill at all.

I spent the rest of the month waiting for 15^th May - this was the date of my caesarean section. I would be 32 weeks pregnant.

The weeks became studded with appointments with oncologists at The Christie to explain my treatment plan – six weeks of chemotherapy (“and yes,” they said, “I would lose my hair.”)

I did get some chance to feel like a “normal” expectant mother by attending my ante-natal appointments, extra scans and finally having steroid injections to help Eliza’s lungs to develop quicker in anticipation of her early arrival.

I now had almost daily contact with a doctor, nurse or midwife. I said to my husband more than once, in tears, that I just didn’t want this to be me, I wanted my old life back.

All I could think about was the cancer. How fast was it growing inside me? Could I afford to wait until May? What about making sure James and Maisie had a Mum around? How could I not give Eliza the best chance of survival when it had been she that had been the reason I was in the right place at the right time?

Fast forward five years and I wish I could shout back in time to my earlier self. “Believe! Eliza is going to be fine, better than fine. This treatment is going to be successful. You’ve got this!”

My emotions ran high again in April 2018 as I had the privilege of running the London Marathon - a lifetime’s dream. Though, it was not my first marathon since treatment, it was in fact number six. Making me a seven times marathoner altogether and I won’t be stopping at the finish line on The Mall.

In 2018 I have set myself the challenge of running five marathons to mark five years in remission - one for each year of survivorship, who else to do it for but The Christie.

I was a runner long before I was diagnosed with cancer, even running through all three pregnancies and ran within weeks of giving birth. I continued to run through my treatment.

The hospital staff encouraged me to continue unless I got to the point where I couldn’t. That point didn’t arrive as I ran three or four times a week, it felt great. I believed that it was one way I could fight my battle, head on. I felt like me when I ran, not a cancer patient, just me.

Once treatment ended I maintained my running routine with Eliza accompanying me in her pram. I started to sign up for races again and I measured my recovery as my times came tumbling down to pre-treatment speeds.

In October 2014, I ran my first post cancer marathon. I was astounded to cross the line in a lifetime best of 03:50:12. Since then I ran more marathons and countless other races, the most recent being the Seville marathon in February 2018 – the first of my five in 2018 challenge.

I have also thrown the gauntlet down to my family and friends, asking if they would sign up to an event which improves their fitness, while pledging to raise money as part of my team – Nicola’s Christie Soldiers.

My view is that while being fit doesn’t prevent you from serious illness, it’s still an investment and better enables you to deal with and recover from whatever health problems you may encounter in the future.

The response I have had has been amazing. I’ve had pledges from friends, family, colleagues, my husband’s friends, friends’ husbands, neighbours, friends of friends – the list goes on. Even the very youngest of my local community are getting involved. The Rainbows are running their own marathon between them one night in the local park.

I was super proud to wear my Christie vest at the London marathon. I am eternally grateful to The Christie for permitting me the opportunity to do this in two ways – successful curative treatment and to offer me one of their prized golden bond places. “Hey - The Christie – I owe you big time!”

Nicola and family have been nominated for a Pride of Bury award, you can vote for her at www.prideofbury.co.uk/the-categories/our-hero-family-award-finalists/

To find out more about how you can support The Christie charity please visit www.christie.nhs.uk/the-christie-charity/

The 6 by 6 Challenge - Tony Gretton

Tony Gretton - Christie fundraiser

I recently completed a ‘6 by 6 challenge’ doing six sporting events/challenges in six consecutive weeks.

I realised that people wanted something more for their sponsorship money. I couldn’t give them blood but I could give them sweat and tears (oh yes and cramps, lots and lots of cramps).

The idea came about a year ago. I had completed two sprint triathlons and a 45 mile bike ride on three consecutive weekends. My thoughts turned to 2018 and my 60th birthday and how I would like to mark it. I decided I wanted to do a real challenge to test my endurance to the limit.

So if you’re thinking of doing a fundraising event, my first tip is to make it a challenge for yourself. Something you’re going to really have to work at to achieve.

Building on my 2017 ‘three in a row’, I decided to add in a longer bike ride, a swim and, well read on if you want to find out. I already knew the dates for the first three events and it didn’t take long to find the others.

My second tip is to plan. You need to have a date to aim at, to focus the mind and help with training.

At the end of 2017, I announced my 6 by 6 challenge. My wife thought I was ‘bloody mad’ – or at least that’s the more polite version!

Thirdly, announce early on what you’re going to do. You’ll be able to gauge interest and people will know early on that you will want them to sponsor you. Plus it adds a commitment to your challenge.

2018 dawned dark, cold and wet. I’d already put in a few months hard groundwork training, but January began the real ramp up and the full release to the big wide world of what I was going to do and when.

The events and dates unfolded thus:

20th May – Sprint triathlon at Lytham St Anne’s where I set a personal best (PB) and finished sixth in my age group.

27th May – Sprint triathlon at Rossendale where I set a PB and finished third in my age group.

3rd June – 45 mile bike ride from Blackpool to Fleetwood area and back.

10th June – 80 mile bike ride around North Wales including two monster climbs, one being the Horse Shoe Pass. Boy did I have some cramps in the last mile and aches at the end of this one, but little did I know what was to come.

13th June (my birthday) – a two-mile open water swim to celebrate being 60 years old!

24th June – Half ironman at Cholmondeley Castle where I came second in my age group. All I can say about this one was that I plain hurt and suffered some of the worst cramps on the run I’d ever had. At 400m from the finish, I actually screamed in pain at the cramps in both legs. I couldn’t take a step. My daughter appeared from nowhere to encourage me on, giving me the spur to keep walking as the cramps eased. Then 200m later there was my granddaughter and we ran side by side for those last yards and crossed the line to the cheers of the crowd. I’d finished my first ever half ironman and the last …. Though there is a part of me that would love to have another crack at it.

When I spoke to my personal trainer she also told me I was ‘bloody mad’ for doing all these events back to back. I didn’t believe her but I do now!

Tip 4 – engage with people who know and understand what you are going to do. Use their knowledge and experience. Think about joining a club that specialises in that type of event and train for it. I told my triathlon club what I was planning and they also said ‘you’re bloody mad’ but they gave me brilliant support.

I then entered a couple of events, the Blackburn 10k where I set a PB and the Liverpool half marathon. The last time I ran this far was just after I’d left the Army, was as fit as a butcher’s dog and was only 24 at the time. Somewhere over the last 36 years I’ve lost 22 minutes and trust me when it says 400m to the water station, suddenly it’s twice as far as it ever used to be.

For all the training, the date of the first event soon dawned and events two and three followed. Event four, the 80 miles around North Wales was my first real test. The furthest I’d ever been on the bike was 60 miles, so this was 20 miles into the unknown, round a very tough course and on a rather hot Sunday. Somehow I managed to get my older brother to sign up to it as well. It was tough, but boy was it glorious. We’d both do it again!

Tip 5 – If you can get someone to come along with you, even if for only a part of what you’re going to do it will make the day a lot more memorable. Believe me, seeing North Wales on the bike is firmly etched into our memories. When I told my brother I would also be doing a half marathon shortly after the bike ride he also told me I was ‘bloody mad’.

The fifth event was only three days later, the two-mile open water swim. It went faultlessly and I only suffered a bit of arm ache in the last 200m. Thankfully, the rain held off until we were back in the car. It’s a funny thing, I hate swimming in the rain …. You get too wet!!

Before I knew it the 24th June arrived. I was up at 4.15 am to get to Cholmondeley Castle.

Tip 6 – Find a great location. If you choose somewhere really nice you’re more likely to have supporters come to watch. You’ll also feel a bit more inspired.

I lined up with another 179 fools (I mean competitors) waiting for the hooter to set us off for the most gruelling sporting event I’d ever done. Seven and a half hours later I crossed the finish line. I hurt, I mean I truly hurt! My wife, daughter and son-in-law were there to see me finish. My six in a row was announced over the loudspeakers and the crowd clapped and cheered again.

The Christie, National Kidney Federation and British Heart Foundation all got a mention. Loads of people spoke to me after about my challenge and asked about the charities and why I chose them. So not only was I able to raise funds, but also elevate the profiles of the charities I was supporting.

Tip 7 – Get your family and friends involved - you can’t do it without them.

Tip 8 – Pick a charity which really means something to you. It’s much easier to sell it to others. You need to tell a story.

Tip 9 – Use social media, but limit your updates prior to the event or you may risk people losing interest. I updated on all my training mileages as it’s a good way to keep a tally.

I promised my wife I’ll never do another half ironman and it’s something I’ll honour. She worried all the way around my final 13 miles of the run. Without her tireless and selfless support, I couldn’t have done it.

On the way home from Cholmondeley we visited Bolton Hospice to see our closest friend Aileen. I kissed her on her forehead and told her I’ve done all six events! Aileen peacefully passed away within a day of us seeing her. And that’s the thing, all the way through the toughest of training and the events, for all the pain I put myself through, I knew I would recover. We always knew Aileen wouldn’t.

I did receive one great piece of news a few days later. A friend and colleague suffering from complete kidney failure had received a new one and was now back at work.

We cannot solve all the terrible illnesses out there, but we need to keep trying. It’s support from the thousands of Christie fundraisers (amongst whom I’m proud to count myself) who help fund vital research and care and treatment for patients. Believe me, every single penny counts.

There are so many people I want to thank including my wife Margaret, for all her fantastic support and the Scarborough radiography department, who raised a phenomenal amount of money for my three causes. There have been some real highs and lows but it’s confirmed my belief in people and there are a lot of wonderful ones out there. And finally, I’d like to thank all the companies that sponsored me.

I hope this inspires readers to do something, too. We have all been affected by the loss of someone close. Use their life to the most positive result that can be achieved, helping to save others.

My challenge is complete - I’m tired, I ache, I’m proud! I wonder what everyone would say if I decided to do it again next year!