One in 500 children in the UK will be diagnosed with cancer by the time they are 14 years of age.

While many children will survive their cancer, survival for some cancers are poor and have not improved for decades. Cancer remains the biggest killer by disease of children in the UK. For those children who do survive, many are left with lifelong, debilitating side effects from their treatment. This needs to change.

Research driving childhood cancer progress

This Childhood Cancer Awareness Month, Children’s Cancer and Leukaemia Group (CCLG) is highlighting the importance of research to helping us realise our vision of a world where all children diagnosed with cancer not only survive but live happy, healthy and independent lives.

In 1977, when CCLG was founded, childhood cancer survival rates were around two in 10, compared to eight in 10 now. This amazing progress has been driven by research, with CCLG at the forefront of much of this improvement. Yet, there is still much more to be done.

Research is the driving force behind not only improving survival for children with cancer, but also minimising the harsh side effects by finding and developing innovative new treatments. Since 2016, CCLG has funded 204 research projects, to a value of almost £30 million, which is helping to lead the way in the fight against cancer.

Help us make a difference this Childhood Cancer Awareness Month

Support CCLG this Childhood Cancer Awareness Month. Your donation could help us to fund pioneering, world-class research that will help change the future for children with cancer.

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Sarah Mitchell

Cancer-Care Pharmacist, Member of the BOPA digital SACT Verification Passport project

Jonathan Knight

CEO & Co-Founder, Tefogo, Member of the BOPA digital SACT Verification Passport project

The systemic anti-cancer therapies (SACT) Verification Passport is a digital solution allowing pharmacy staff to move between organisations and take a record of their training with them.

Pharmacy plays a crucial role in cancer treatment, particularly in managing chemotherapy and other SACT. These therapies — ranging from traditional chemotherapy to advanced immunotherapies and CAR-T cell treatments — are highly complex and carry significant risks, including severe side effects and death.

Specialist pharmacy training

Ensuring that each patient receives the right medicines, at the right doses and at the right time requires specialist pharmacists. These professionals undergo extensive training beyond the five years of university and foundation training, which is required to legally qualify as a pharmacist within the UK.

Not only does this boost efficiency, but
it also enhances the safety and quality
of care for cancer patients.

Training challenges

In 2022, the British Oncology Pharmacy Association (BOPA) identified major inconsistencies in how this training was provided across the UK. Some organisations had overlapping training programmes, leading to inefficiencies when pharmacists moved between hospitals.

SACT Verification Passport solution

The BOPA digital SACT Verification Passport is an innovative solution developed in partnership with the Compassly app. The passport delivers modules of training in the form of multiple choice questions, mock situations and tracks training as well as other features.

It allows pharmacists to carry their certification between organisations, standardising the level of training across the UK. The passport saves time and resources by eliminating duplicate training UK-wide while making it easier to track and update qualifications within organisations.

Not only does this boost efficiency, but it also enhances the safety and quality of care for cancer patients. With global interest already growing, the SACT Verification Passport could become a model for cancer pharmacy training worldwide.

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Intraoperative ultrasound imaging technology is being used in brain tumour operations to give surgeons a view of the brain and help them make real-time surgical decisions.

Ultrasound imaging has long been a fixture of the radiology department and antenatal clinic, allowing healthcare professionals to make diagnoses and monitor the development of a baby in the womb. Yet, there are versions of the technology, like intraoperative ultrasound, that can also play a critical role during complex surgical procedures — including operations to remove brain tumours.

Intraoperative ultrasound benefits in surgeries

“Before surgery, the patient will usually have an MRI scan to show the location and size of a tumour,” explains Mr William Lo, Consultant Neurosurgeon at Birmingham Children’s Hospital. “However, the brain is a soft structure, which moves and shifts during the operation, so these pre-acquired images no longer represent what the surgeons are dealing with.

This is why intraoperative ultrasound is so helpful. During the operation, an ultrasound scanner provides the surgeons live images of the tumour and its precise location, including the depth not visible to the naked eye — as well as real-time information about the vessels and normal brain structures surrounding it. The information enables the surgeons to modify their surgical decision-making. Unlike X-ray-based imaging, there is no exposure to radiation.

Live images of tumour boundary during operations

At Birmingham Children’s Hospital, Mr Lo and his team routinely use the technology in various surgical scenarios, including brain tumour resections. “When performing a brain tumour resection, the aim is to remove as much of the tumour as possible to increase the chance of survival and reduce the risk of recurrence,” he says. “Ultrasound helps us visualise exactly where the tumour ends and where the healthy brain tissue begins; in other words, the resection margin. Staying along this boundary helps preserve the patient’s neurological function — for instance, movement, speech and visual function.”

The image quality from a modern
scanner is excellent, and the design
of the machine is user-friendly.

In 2021, Birmingham Children’s Hospital acquired a new intraoperative ultrasound system to improve patient outcomes. “Ultrasound technology is continuously improving,” says Mr Lo. “The image quality from a modern scanner is excellent, and the design of the machine is user-friendly, making it easier for surgeons to obtain useful visual information when they most need it.”

Enhanced precision and safety in brain biopsies

In some cases, the brain tumour is in a deep or sensitive location, and therefore, resection is inappropriate. The diagnosis then relies on a minimally invasive biopsy, where a needle is passed into the brain to obtain a small sample of the tumour. By providing live images of the needle, ultrasound provides reassurance and confirmation that the surgeons have reached the target safely.

Risk reduction advantages for patients

The ability to ‘see through’ the brain, in real-time during different kinds of brain tumour surgeries allows neurosurgeons to carry out the procedures more accurately and effectively. This ultimately improves patient safety, surgical outcomes and overall care quality for brain tumour patients.

Brain tumour surgery with intraoperative ultrasound frees patient from epilepsy seizures

Roxy Croxford

Patient

Roxy Croxford’s brain tumour was successfully removed with the help of intraoperative ultrasound — technology that gives surgeons a real-time view of a lesion’s location.

Two years ago, at 14, Roxy Croxford had a strange feeling in her right leg. “Tremors started running through it — shaking that lasted for a couple of minutes,” she remembers. “This started to happen three or four times a day.”

Impact of childhood brain tumour

Her condition got progressively worse. During a family holiday, Roxy had a shaking attack that was more violent than ever. Back in the UK, she had a full seizure. Ultimately, Roxy was referred to a specialist at Warwick Hospital and diagnosed with epilepsy.

“Epilepsy meant I couldn’t walk to school on my own in case I had a seizure,” says Roxy. “It affected everything. I couldn’t even sit on the top deck of a bus in case I fell down the stairs and couldn’t go swimming without telling the lifeguard about my condition. It’s extremely debilitating.”

I’m not as scared that I’m going
to randomly have a seizure while
walking down the street.

Being identified as a candidate for brain surgery

Despite the medication, the seizures persisted. The results of the MRI showed the cause: Roxy had a growth on her brain — a low-grade glioma (usually benign) located in the area that controlled leg movement. She was referred to Birmingham Children’s Hospital where she was identified as a candidate for surgery under the care of Mr William Lo, Consultant Neurosurgeon.

Mr Lo and his team carried out the operation earlier this year using intraoperative ultrasound, which shows surgeons a live, real-time view of the tumour and its precise location. It gives confidence to the surgical team that the tumour was completely removed without comprising the important surrounding normal brain tissue.

After its successful removal, the tumour was confirmed to be benign. Roxy has been seizure-free since. “Forty-five minutes after coming round from surgery, I was sitting up, eating,” says Roxy. “Mr Lo has been fantastic. He explained what was going to happen in a simple and matter-of-fact way, so we knew what the plan was and adhered to it.”

Roxy is now getting back to all the things she enjoys doing. “When I go out, I’m not as scared that I’m going to randomly have a seizure while walking down the street,” she says. “I feel much more confident about what I can do.”

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Cancer care in Wales is advancing with the ambition to improve survival rates, which currently fall behind those of many other countries, including ones of similar size and wealth.

Driving innovation to frontline services is essential, enabled by building enduring partnerships across sectors to rapidly translate research into practice and co-develop solutions. We’re investing in strengthening our health and care system to become an early adopter of transformative innovation.

Cancer care priorities

Wales’ Cancer Improvement Plan and National Cancer Research Strategy identify key priorities focused on prevention, earlier detection and personalised cancer care through genomics. Research themes include precision and mechanistic oncology, immuno-oncology and data-driven predictive analytics.

Investment in key infrastructure includes the All-Wales Medical Genomics Service, Wales Cancer Bank, the Wales Cancer Research Centre and data infrastructure including the SAIL Databank and Artificial Intelligence Commission.

We’re playing a critical role in supporting the
Welsh Government Tackling Cancer initiative.

Lung cancer remains the leading cause of cancer deaths; skin cancer cases are rising; and urological, breast, colorectal and gynaecological cancers present significant burdens.

Accelerating cancer innovation

New service models and technologies are being rapidly co-developed, such as the QuicDNA programme, which offers liquid biopsies for early lung cancer detection. This programme is currently being trialled with a consortium of international partners.

We’re playing a critical role in supporting the Welsh Government Tackling Cancer initiative. Fostering collaboration between industry, healthcare, academia and charities to accelerate the deployment of innovative cancer care solutions. Wales is seeking to co-develop and adopt at pace. Join us in the fight against cancer.

Pitch your cancer innovations here: lshubwales.com/innovation-enquiry-form.

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Digital pathology has the potential to improve patient care and support the pathology workforce by making the diagnosis and monitoring of disease much more efficient. Embedding digital pathology lays the foundation for the adoption of artificial intelligence (AI) in diagnostic services.¹

What is digital pathology?

Usual practice involves pathologists looking at a tissue removed during a biopsy on a glass slide through a microscope to check for disease. The move to create digital pathology, involves the slides being scanned to generate digital images that can then be viewed by pathologists on a computer screen.

Digital pathology and efficiency

This digitisation provides flexibility and agility, which makes diagnostic workflows more efficient.

Cases are rapidly transferred between organisations and across pathology networks; access to expert pathologist second opinion is sped up, improving turnaround times and diagnostic pathways and ultimately benefiting patients.

Indeed, digital pathology has the potential to revolutionise the way pathology services are delivered, particularly in cancer diagnostics where the volume and complexity of samples continue to increase.

Access to expert pathologist second
opinion is sped up, improving turnaround
times and diagnostic pathways and
ultimately benefiting patients.

Potential for innovation in pathology

The digital images generated have been used to train algorithms to detect cancer and grade it. Early evaluations of AI for prostate cancer detection are being undertaken in several sites in the UK and the USA.

These evaluations are ongoing to establish where and how AI can help the diagnostic process; for example, by helping to triage cases requiring rapid assessment, ordering additional tests to save time and helping the pathologists evaluate the tissue.

Investment required for digitisation

However, investment is needed in the form of scanners so these glass slides can be digitised. There also needs to be investment in IT to ensure systems can support this digitisation and integrate other vital information that will assist pathologists in making a diagnosis, such as a patient’s clinical history. Only with the creation of this modern digital environment will AI be successfully implemented — and its benefits realised.

[1] The Royal College of Pathologists. RCPath Artificial Intelligence position statement (2023). Digital pathology (rcpath.org)

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Professor Tobias Arkenau

Global Head of Drug Development and Chief Medical Officer, Ellipses Pharma

Graeme Horne

Head of CMC, Ellipses Pharma

Using holistic approaches is helping a major drug developer create and test drugs more quickly and cost-effectively to benefit patients.

Often, years of research can result in failure, with millions of pounds spent without a new drug making it to patients. Drug development company Ellipses Pharma believes its business model streamlines the process and enables pharmaceutical companies to get tried and tested compounds to market quicker.

Patient and drug manufacturer advantage

Focusing on oncology and a core purpose to accelerate development of cancer treatments, CEO and Co-Founder Dr Rajan Jethwa believes the company’s efficient approach has clear benefits to patients and drug manufacturers.

His company acquires drugs in their infancy from other developers and refines them through rigorous testing, research, trialling and problem-solving. They aim to prepare them for sale to pharmaceutical companies.

“If we do it well,” says Dr Jethwa, “we have a much higher chance of those drugs being successful. We improve our chances by engaging specialist cancer doctors and scientists at an early stage and designing the preclinical and clinical development plans, taking their guidance into account.”

De-risking drug development

Given the time-limited span of a patent, which can start well before the drug is commercially available, time saved in medicine development gives pharmaceutical companies a longer exclusive window to sell the product.

That is against a backdrop of changed public perceptions in drug development timescales following the Covid-19 pandemic where a vaccine was developed quickly. The company ethos is designed to de-risk a drug’s development while saving time and money.

Properly funding the development stage is pivotal. “That is our core pillar. We call it uninterrupted development capital, an uninterrupted flow of money that allows us to ensure each drug is funded properly without adding delays by having to stop and restart development with intermittent funding,” Dr Jethwa explains.

“That can save 3–6 years of additional patent life for the drug and leads to patients getting the drug sooner and for longer.” With seven out of every eight potential cancer drugs never reaching patients, de-risking chances of failure increases chances of success.

We are selecting a drug that already has
support from clinicians and designing
a trial that ensures the drug is tested
in the right patient population.

Prof Tobias Arkenau

Designing trials with clinician support

Before acquiring a drug, the company consults its Scientific Affairs Group of 300 global key opinion leaders — doctors, experts, peer reviewers — engaged anonymously via a bespoke digital platform developed by Ellipses for their views on the science and potential development gaps.

“The aim is to get consensus around how good the science behind a drug is,” explains Prof Tobias Arkenau, Global Head of Drug Development. “The next stage is designing the clinical trial in the right way; patient stratification, making sure the right patients go into the right trial for the right drug at the right time is hugely important,” he adds.

“These two things help to de-risk drug development; we are selecting a drug that already has support from clinicians and designing a trial that ensures the drug is tested in the right patient population. All of that should lead to a better success rate.”

Processes to help patients survive longer

Ellipses follows defined processes to tackle various challenges: determining the right amount of active compound, assessing environmental impact, scalability, patient-friendliness, regulatory compliance and evaluating toxicity and side effects. “We navigate these processes in parallel to get to a point in advance of first-in-human trials, knowing all the problems have been solved,” says Dr Graeme Horne, Head of CMC.

“The pillars of de-risking, asset selection and how a trial is built and designed, coupled with uninterrupted flow of capital and executing a clinical trial efficiently and effectively leads to more drugs developed in a faster timeline with a higher rate of success,” adds Dr Jethwa.

Moreover, he points to a plethora of benefits for patients who get a drug sooner. “The drugs have been rigorously tested, are shown to be safer and efficacious in treating disease for longer. Ultimately, we want patients to survive longer with a better quality of life.”

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Professor Tobias Arkenau

Global Head of Drug Development and Chief Medical Officer, Ellipses Pharma

Clinical trials of novel therapies for leukaemia, breast and lung cancer are showing promising signs in treating these cancers in patients today.

A number of cancer therapies in development are showing promising results in clinical trials and emerging as potential alternatives when existing treatments falter or fail.

Ellipses Pharma, a precision drug development company focused on oncology and aiming to accelerate the development of new cancer medicines and treatments, is developing next-generation targeted therapies for patients with leukaemia, breast and lung cancer.

Rigorous testing and assessment in global clinical trials

Chairman and Co-Founder Prof Sir Chris Evans OBE explains how the company acquires promising new drugs from other organisations before they go into human testing and then develops them into potential new treatments in clinical trials so that patients have more options on their cancer journey.

“The drugs being developed at Ellipses are next-generation therapies to effectively target genetic abnormalities found in certain tumours. Each potential medicine undergoes rigorous testing and assessment in specialist cancer centres around the world,” he says.

Next-generation selective RET inhibitor for lung and other cancers

One of the new drugs for lung and other cancers targets a dysfunctional protein called RET (rearranged during transfection). Prof Tobias Arkenau, Chief Medical Officer and Global Head of Drug Development, outlines how the drug inhibits the protein, stops the uncontrolled division of the cells and destroys cells that are part of a tumour. “By inhibiting the RET protein that is driving the cancer’s growth, it is stopping the cancer from growing,” he says.

The drug is a next-generation selective RET inhibitor and has completed a phase 1 trial in patients with RET positive cancers, ascertaining what the most effective doses look like, and is now entering phase 2 studies having acquired orphan drug and fast-track designation in the US, which should accelerate the process towards wider patient use.

Prof Arkenau says it is showing encouraging results in patients who have become resistant to first-generation RET inhibitors or whose cancer has spread from the lungs to the brain and other organs.

By inhibiting the RET protein that is
driving the cancer’s growth, it is
stopping the cancer from growing.

Prof Tobias Arkenau

New drug for patients with hormone receptor-positive breast cancer

In the area of advanced breast cancer that has returned or progressed after initial treatment and moved outside of the breast, Prof Arkenau believes there remains a ‘high unmet need’ for specific patient groups.

The company is currently enrolling breast cancer in patients who have progressed on current hormonal therapies into their new selective androgen receptor modulator (SARM) trial that has returned promising results in patients whose cancer expresses both oestrogen and androgen receptors.

“This works by ‘fuelling’ the androgen receptors, almost starving the cancer of its oestrogen signalling and subsequently leading to cancer cell death,” he adds. “We expect to combine this new SARM with existing therapies to see even better responses in patients and for longer,” continues Prof Arkenau. The drug is now going into combination studies in the US, Europe and the UK.

Leukaemia drug for patients not responding to current treatment

A third drug under development is for patients with acute myeloid leukaemia (AML), where leukaemia cells growing in the bone marrow replace healthy red and white blood cells and subsequently result in bone marrow failure.

“AML is a very complicated blood cancer,” says Prof Arkenau. “Often driven by multiple genetic abnormalities.” He notes that leukaemic cells can become resistant to standard therapies even after stem cell therapy, and relapse is common. The drug being trialled is a dual inhibitor targeting a specific set of proteins that are known to be involved in cancer resistance and progression.

Patients at the relapsed-refractory stage, where standard treatment has consistently failed, have been participating in a phase 1 trial. The results were very encouraging which allows progression of the study to combine Ellipses’s drug with other approved therapies in a phase 2 trial.

It marks yet another stage of the company’s ongoing development of drugs aiming to improve the quality of life for cancer patients.

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Abigal Tomlins

Consultant Breast Surgeon, Gloucestershire Royal Hospital,
British Association of Surgical Oncology – The Association for Cancer Surgery

Discover the latest in personalised breast cancer care and treatment options. Learn about imaging advancements and targeted therapies for improved outcomes.

Breast cancer, the most prevalent cancer globally, has seen enhanced survival rates following collaborative efforts and targeted therapy breakthroughs. Personalised care tailors treatment and prevention to individuals, considering genetic tumour variations, lifestyle factors and health conditions.

Imaging increasingly guides decision-making and treatment planning — from diagnosis to management of advanced disease, reducing the extent of surgical treatment and minimising cosmetic impact and potential long-term sequelae.

Personalised breast screening and early diagnosis

Breast screening has traditionally been via mammogram with geographical variations in the intensity and age groups screened. Variations in breast density, even in postmenopausal women, increasing use of HRT and rising incidence of breast cancer in perimenopausal women question the validity of this approach and the need for density-stratified/adapted breast screening.

The BRAID trial is evaluating modalities such as MRI, CESM and ABUS. High-risk surveillance using MRI for those with genetic alterations facilitates earlier diagnosis.

Imaging is crucial for breast screening in developed nations, yet, it is impractical in many countries. Early diagnosis through patient education and adequate healthcare resources are key to reducing breast cancer mortality.

Oncoplastic treatment choices and de-escalation of treatment

DBT, CESM and MRI enhance surgeons’ confidence in extending breast conservation through wider adoption of oncoplastic breast conservation surgery techniques, improving patient quality of life.

Wire-guided localisation of impalpable lesions has broadly been replaced by modern techniques like RFID, magnetic and radar localisation for increased patient comfort and theatre efficiency.

De-escalating axillary surgery, supported by evidence, can reduce complications such as lymphoedema; and MRI has been shown to predict response to neoadjuvant chemotherapy, driving down the need for mastectomy.

Imaging is crucial for breast
screening in developed nations,
yet, it is impractical in many countries.

Targeted therapies must be cost-effective for global access

The development and adoption of genomic assays for ER-positive and HER2-negative cancers to assess chemotherapy benefits has been a big step forward for personalised care. The advent of targeted therapies (anti-HER2) and immunotherapy (for ER-positive and triple-negative cancers) can potentially improve outcomes for breast cancers. The cost of these therapies must be decreased to allow ‘all-inclusive’ global access to minimise variation.

Role in advanced disease management

PET-CT enhances distant disease assessment over standard imaging, identifying oligometastatic disease treatable with modalities such as SABR, potentially improving curative outcomes and duration of progression-free survival.

The rising incidence of breast cancer, coupled with better treatment, means more people are living longer. Individualising cancer care, minimising morbidity and maximising benefits through early diagnosis and tailored therapies can lead to optimised, evidence-based breast cancer management.

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It is increasingly vital to boost the cancer care workforce in the NHS and encourage new students to take up training.

Medical physicists, technologists and clinical engineers are the backbone of cancer care delivery. These highly trained scientists diagnose and treat patients and are an essential part of the healthcare team alongside radiographers, oncologists and nurses.

Medical physicists, technologists and clinical engineers

Dr Anna Barnes, Consultant Clinical Scientist and President of the Institute of Physics and Engineering in Medicine (IPEM), says: “These roles are both multifaceted and crucial for the safe and effective delivery of a multitude of services underpinning the NHS.”

They carry out technical assurance tests, radiation safety checks, implementing quality control measures and optimising machinery with the use of computer-aided design. “They programme how treatment delivery machines provide the exact amount of radiotherapy needed while avoiding non-cancerous cells,” she adds.

Referring to their role as ‘the oil in the wheel,’ Dr Barnes explains they are a vital part of designing and planning treatment schedules within radiotherapy, molecular radiotherapy and nuclear medicine while translating research into clinical workflow. According to IPEM, medical physicists and clinical engineers contribute to 45% of all treatments within NHS hospitals.

The UK does not have enough
healthcare scientists, engineers and
technologists to deliver essential services.

Challenges of the workforce

Dr Barnes explains: “The UK does not have enough healthcare scientists, engineers and technologists to deliver essential services.” While those currently in the workforce are asked to ‘do more and more with less and less,’ it is also increasingly difficult to train new members of staff.

“To maintain this extraordinary level of expertise, it is essential that we have enough new people coming through science, technology, engineering and mathematics (STEM) education and into training routes now,” she insists.

Supporting healthcare scientist roles

Dr Barnes, passionate about addressing these challenges, speaks of IPEM’s role as the workforce’s professional body. “We provide a community for healthcare scientists, industry and academic colleagues to share ideas and best practices, to promote the profession and encourage more people to consider it as a career,” she says. Additional funding and student uptake can help tackle workforce shortages and recruitment issues, helping this ‘hidden workforce’ to be recognised.

The post Addressing shortfalls within the ‘hidden’ cancer care workforce appeared first on Health Awareness.

Digital diagnostic innovations can tackle UK cancer treatment backlogs, saving lives and meeting patient demands. Technology enables early detection and treatment.

Digital diagnostic innovations can help an understaffed and under-resourced health service to prevent a possible 20,000 avoidable cancer deaths annually by 2040. It can also ensure Britain meets the growing demand from cancer patients for early diagnosis and treatments. 

Harnessing technology for cancer detection innovation

Recent technological innovations, such as the AI platform being developed by Dell and the University of Limerick, will showcase how predictive and diagnostic research in oncology can significantly improve early cancer detection and alleviate NHS backlogs.

The Department for Health and Social Care’s (DHSC) adoption of digital pathology to screen for certain cancer types is a timely step to accelerate cancer detection and treatment by improving lab efficiency, enabling second opinions on samples and expediting diagnosis. Digital pathology is a crucial component of the DHSC’s 2023 ‘Medtech Strategy,’ which sets out how medtech innovations can improve assessments of health risks.

With a general election approaching, the next
government has clear incentives to continue
developing a long-term cancer strategy.

Investing in diagnostics cuts wait times

Research and investment in innovative technology have also enabled the DHSC to highlight the benefits of early cancer diagnosis. According to recent official figures from the DHSC and the NHS, increased investment in community diagnostic centres through the Centres for Disease Control and Prevention (CDC) programme has helped reduce waiting times in the past two years.

Cancer Research UK have also highlighted the economic benefits of improvements in cancer research; prevention and care help to reduce health and social care costs and can improve workforce productivity and quality of life.

Government urged to prioritise cancer strategy

With a general election approaching, the next government has clear incentives to continue developing a long-term cancer strategy that complements and builds on the ‘Medtech Strategy’ to enable the early adoption of diagnostic innovations. The UK’s ambitions to lead in science and innovation may yet depend on the Government’s ability to define this strategy.

Early adoption of digital innovation can relieve the NHS backlog, increase the resources and professional bandwidth of healthcare professionals and, crucially, serve patients promptly to increase survival rates. 

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