Friday, 26 April 2019

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.

Tuesday, 26 March 2019

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.

Tuesday, 19 February 2019

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.

Thursday, 3 January 2019

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.