“Close the Care Gap” - World Cancer Day 2023

In the global battle against cancer, World Cancer Day is an opportunity to recognise and celebrate the power of working together. Whilst a cancer-free world may still be a distant vision, the pace of technology innovation and adoption is driving us closer to the day when we can live with cancer – and the real hope of extended survival and improved quality of life.

“Close the Care Gap” is now in its second year and World Cancer Day therefore is an opportunity for the GenesisCare teams to reflect on our own contribution to reducing the global impact of cancer. As a leading independent provider of specialist cancer care, we have a responsibility to invest in new technologies that have the potential to improve outcomes. Often, we are first to market, and our role as a global innovator comes with an obligation to extend the body of evidence, share what we’ve learned and pave the way for the inevitable adoption of these new techniques into mainstream medical practice.  

MRI-guided radiotherapy is one example. The use of magnetic resonance imaging in the delivery of radiotherapy is revolutionising its role in cancer treatment. It enables high-definition images of tumour and normal tissue anatomy during treatment, allowing clinicians to deliver curative doses of radiation to tumour sites that are in close proximity to other organs and might otherwise be difficult to treat. As the first healthcare provider in the UK to introduce MRIdian MRI-guided radiotherapy, GenesisCare immediately recognised the full potential for this technology for a range of cancers, including a number where treatment options were limited, and outcomes were poor. We have an active partnership with the University of Oxford to provide access to the MRIdian within clinical trials, with a focus on areas on unmet clinical need. Pancreatic cancer was highlighted as one priority, where early trials had provided signals of improved local control and increased overall survival (OS) using a regimen of dose escalation with stereotactic ablative radiotherapy (SABR). This technique causes less interruption to systemic therapy and less time spent in hospital than conventional radiotherapy, however the proximity of the pancreas to surrounding organs has historically meant we were unable to safely deliver high doses of radiotherapy. MRIdian MRI-guided radiotherapy is a proven solution, enabling high-dose SABR to be delivered with crisp visibility, allowing clinicians to carefully avoid organs at risk, even as they move with breathing.

In 2020, we formed a partnership between the GenesisCare Foundation, the Pancreatic Cancer Research Fund, ViewRay and the University of Oxford to launch the Compassionate Access Programme (CAP), recruiting 50 NHS patients from over 30 Trusts. The aim of the programme was to:

• Provide access to MRI-guided SABR free of cost to patients with medically inoperable, locally advanced, borderline resectable, or locally recurrent pancreatic cancer, particularly where other treatments weren’t available during the pandemic
• Build the evidence base for using MRI-guided SABR in the treatment of pancreatic cancer and to share this knowledge and expertise with the other UK pancreas MDTs
• Support the worldwide research community to find new and better ways to treat pancreatic cancer

The early success of this programme went on to help shape the NHS commissioning of SABR for pancreatic cancer and informed the design of subsequent randomised clinical trials – including the ongoing EMERALD clinical trial, which explores the potential for dose escalation in pancreatic cancer. The trial will evaluate the safety and efficacy of shortening treatment, from five sessions down to three and then just one session. Early toxicity results are expected by the end of next year (2024). In the meantime, GenesisCare continues to work with a group of expert clinicians to push the boundaries of skill and expertise on the MRIdian, treating other complex sites such as central lung and adrenal tumours and sharing experience with colleagues.

The importance of SABR in the cancer pathway has increased significantly in recent years, with NHS commissioning for lung and oligometastatic disease. To maximise patient access to this transformative but often complex technique, we have credentialled over 50 oncologists in the art of selecting patients for treatment and planning safe and effective SABR, using both conventional CT-guided techniques as well as MR-guidance.

There are many ways in which the independent sector can bridge gaps. For example, the oncologists and surgeons that work within GenesisCare very often also work in NHS posts and this ensures the flow of experience and best practices gained in the independent sector back into the NHS. 

As a global organisation and a leading independent cancer provider we all share the same passion for making a difference to patient’s lives everywhere and finding new ways to treat that will help close the care gap in cancer.