Day One: Tuesday 18th October 2022

Following a warm welcome and the consumption of numerous coffees and pastries (for those who were lucky to grab one before they all disappeared), members of the audience made their ways to the conference room.

Well known host of ‘You, Me and the Big C’, Steve Bland, opened the conference, giving a welcoming introduction and overview of what to expect over the next couple of days.

Plenary 1 – Cancer in context: How are we doing?

This session was chaired by Professor Dave Shackley, with talks from NHS England National Cancer Perspectives Dame Cally Palmer, Greater Manchester Health System Perspectives Dr Manisha Kumar, Greater Manchester Cancer Alliance Perspectives Claire O’Rourke and Alison Armstrong and Patient Perspective Tony Collier BEM.

These talks were followed by a group panel discussion and audience Q&A.

Key take home messages:

• Cancer early detection is of paramount importance; It is now at approximately 55%; Eight out of ten GM boroughs have seen an increase in early detection
• A quarter of GM residents live in the most deprived 10% of areas in the UK; this is the single biggest driver of ill health
• By 2028, it is a goal to have ¾ of cancer patients diagnosed at stage one and two and 55,000 people surviving more than five years

Plenary 2 – Innovation in Screening

Session two was chaired by Professor Phillip Crosbie, featuring Professor Caroline Dive, Professor Emma Crosbie, Professor Richard Booton, Dr Jen Davies-Oliveira and Mr Rajiv V Dave.

Developing Liquid biopsies for early detection of lung cancer with Professor Caroline Dive:

Together, Professor Crosbie and Professor Dive discussed their work taking blood from a patient’s pulmonary vein to identify epithelial cells in early-stage cancers. This was published in Nature Medicine in 2019. Professor Dive also discussed her involvement in the GRAIL trial looking for early signs of cancer.

• Liquid biopsies can look for circulating tumour DNA (ctDNA) and circulating tumour cells (CTCs) which are signatures in the early stages of cancer development.
• Professor Dive collaborated with Professor Phillip Crosbie on the Lung Health Check, to develop a high specificity blood test that can be taken simultaneously with a CT scan; This can be linked to GM care records to track future changes in patients

Targeted Lung Health Checks and Mobile Prevention Early Detection with Professor Emma Crosbie & Professor Richard Booton

Professors Emma Crosbie and Richard Booton further built upon the discussion of the Lung Health Checks and described how this activity has provided a step change in lung cancer detection across Manchester and how the programme is being expanded across the UK and trial the detection of other cancer types. The key takeaways from their talk were:

• The Lung Health Check was developed as a bespoke clinic that allowed patients to receive a CT scan in places such as car parks and football stadiums in deprived areas
• Attendees were simultaneously screened for COPD and cardiovascular disease
• The UK government is now spending £250 million per year on this incentive; there is now one lung health check in every cancer alliance
• Emma Crosbie is now working to screen high risk women over the age of 65 who attend this initiative for cervical cancer

Alternative Cervical Screening with Dr Jen Davies-Oliveira

Dr Jen Davies-Oliveira discussed the ACES study which aims to develop accessible and reliable cervical screening methods:

• One in three individuals do not take up a cervical screening offer such as difficulties including accessibility, embarrassment and pain of examination
• The ACES Colposcopy study looked at the efficacy of urine testing at picking up high-grade HPV and addressing barriers to screening
• Jen discussed the acceptability parameters of this study which showed participants found the screening method to be highly acceptable

Breast Screening in Kenya with Mr Rajiv V Dave

Linking to a talk on Day Two about internationalisation activities, Mr Rajiv Dave discussed how an ongoing collaboration between Kenyatta University Teaching, Referral and Research Hospital and The University of Manchester, The Christie, and Northern Care Alliance is expanding into breast cancer.

• In 2019 the UK and Kenya partnership was established, where a MoU was set up between the Kenya-UK health alliance
• The aims of this partnership were to build capacity and develop research in breast, cervical and oesophageal cancers
• This partnership now involves Kissii University and KUTRRH in Nairobi alongside Mombasa
• It has been identified that mammograms need to be different in Kenya, and that screening needs to be seen as an alternative model for early diagnosis

GMCC Awards 

The evening of the 18^th saw the team attend the first GM Cancer Awards ceremony. Created to celebrate the projects from across the entire cancer research pathway, competition was strong as over 60 applications were summarised down to just six winners. Following an inspiring introduction from Mayor of Greater Manchester Andy Burnham and Steve Bland, the winners were announced:

• The Outstanding Care Award went to “Teaching Patients and Carers to Inject Chemotherapeutic Drugs at Home” by the Northern Care Alliance team
• Commitment to Equality Award went to: “Encouraging Inclusivity in Technology Clinical Trials Project” by the dECMT
• Greater Manchester Collaboration Award went to: “Primary Care Network Collaboration in Greater Manchester” by the GM Cancer Alliance
• Research Award went to “Testing womb cancer for Lynch syndrome: How Manchester-led research changed UK clinical practice” by Prof. Emma Crosbie and The University of Manchester team
• Educational Impact Award went to “Making Smoking History in Greater Manchester” by the GM Integrated Care Partnership
• Innovation Award went to “MyChristie-MyHealth – The Christies ePROMs” project by The Christie

Day Two: Wednesday 19^th October 2022

Day two began with more discussions about the personalisation of care in cancer. As Maria Lawal, a patient representative, equality in cancer care is when the everyone is offered access to the same level of support in their local community. To achieve this goal of personalising therapy, Dr Steve Churchill outlined a new strategy based on five steps:

• Step 1: Holistic needs assessment – assessment of a patient’s needs to find out what needs to happen in a hospital when diagnosed
• Step 2: Personalised care support plan
• Step 3: Treatment summary – encourage patients to also look out for recurrence
• Step 4: Personalised stratified follow up – looks at people and how they can be monitored
• Step 5: Cancer Care Review – how are patients’ managing

In Greater Manchester, this step process is being enabled by digital technology and access to genomics testing at the Genomics Laboratory Hub, aiming to ensure no-one is excluded from genomics testing. This has already been implemented in many research projects with speaker Dr Glenda Beaman already working with researchers Dr Ashwin Sachdeva and Dr Emma Woodward on multiple research projects.

Moreover, as outlined by Molly Pipping, in 2022, GM Cancer also initiated a new programme focused on Workforce and Education, aiming to develop and grow the cancer workforce and bridge the gap between primary and secondary care.

A major theme of day two was about embedding collaboration into our culture to enable success. Focusing first on collaborating internationally, Professor Keith Brennan outlined how a new Manchester-Melbourne-Toronto (MMT) tripartite partnership aims to enhance international collaboration and embed new discoveries in cancer research. Similar to the Manchester Kenya project that Rajiv outlined on day one, the MMT partnership is about bringing the right people together to enable great research to flourish.

This was followed up by Dr Suzanne Johnson outlining how important patient and public voices are in developing impactful research. Suz argued that Patient Public Involvment and Engagement (PPIE) should be an essential part of the research culture, breaking the system of how things have been done in the past and getting patients and the public involved from inception through to delivery of a project.

Suz outlined two wasy this is being actioned in Manchester. The first, through a new online course available through The University of Manchester: Transformative Oncology PPIE is integrated into the course’s delivery to train the next generation of cancer researchers about the importance of developing the opinions of members of the public.

Secondly and building on Keith and Rajiv’s talks, Suz outlined one of the projects formed during the collaboration between Kenya and Manchester. Owing to the differences in cancer type, healthcare system and structure, and the infrastructure on the ground an out of the box solution that works in Manchester would never be applicable directly to tackle the challenges facing Kenyan patients. Instead, by listening, and co-creating and co-developing a research project, Manchester and Kenya have developed a mutually beneficial research project that will have a major impact for patients in Kenya.

Summary

Following the conference, we were all left with a sense of pride and accomplishment in what the GM Cancer team had accomplished. We’d heard inspiring talks, met some wonderful people doing some outstanding work in care delivery, research, and education and of course met and heard first-hand how cancer affects individuals. While we’ve come a long way now that one in two of us will survive with cancer for 10 years or more, we’ve still got a way to go before we can create a future free from the burden of cancer.