Tackling the ‘London effect’ is saving lives in the capital

A collaboration is underway in London to improve cancer survival rates, as Liz Bestic reports

Average survival rates for cancer in London are worse than for the rest of the country because of factors such as access to services, poor health awareness and cultural variations.

Now cancer services in the north and east of the capital have come together with west Essex as London Cancer, and aim to radically improve provision.

London Cancer is responsible for the cancer care of 3.5 million people and is made up of 12 trusts, including three major London teaching hospitals, Barts, University College London Hospitals (UCLH) and The Royal Free.

“When we were offered the opportunity by NHS London to transform London’s cancer services, we seized the chance to do something truly innovative to drive up standards and improve access to excellent treatment for all patients,” says Professor Kathy Pritchard-Jones, London Cancer’s chief medical officer.

So what does this mean for patients with prostate cancer? “London has a very diverse population and addressing cancer awareness in the community is vitally important,” says consultant urologist Professor John Kelly of UCLH. “Up until now, access to treatment has been variable and different treatments were offered at different local hospitals.

“Our plan for London is to establish excellent care, bringing together specialist cancer surgeons into a single team, and to use innovative treatments, such as robotic prostatectomy alongside novel radiotherapy treatments and new experimental treatments such as HIFU [high-intensity focused ultrasound]. We also need to select the right people for treatment so we can minimise treatment-related side effects in as many patients as possible,” says Professor Kelly.

“It may seem obvious, but the more operations surgeons perform, the more proficient they become. If we look at our outcomes – positive margin rates – they are already far better than we ever anticipated. That’s a direct result of the high-volume, highly specialist, expert teams,” he says.

Consultant medical oncologist at Barts Dr Thomas Powles believes the critical mass provided by London Cancer is a key to developing new therapies. “We are the first site outside the United States running clinical trials on novel immune therapies, such as Provenge,” says Dr Powles.

Up until now, access to treatment has been variable and different treatments were offered at different local hospitals

“We also offer the latest bone-targeted therapies, such as Alpharadin [radium-223 chloride] and a whole second generation of immune-based therapies. These are four new weapons in the fight against prostate cancer which simply were not available to us five years ago,” he says.

London Cancer is also providing top-of-the-range educational facilities for experienced surgeons as well as newly qualified doctors. The Chitra Sethia Centre for Robotics and Minimal Access Surgery at UCLH is the UK’s first robotic training centre. Surgeons come from all over the world to be trained and medical students – the surgeons of tomorrow – have access to a suite of computer-guided surgical simulators and two robotic systems, each costing £1.5 million.

London Cancer does not see itself as an “ivory tower” specialist centre, but as an integrated cancer care system, with the expertise of 12 trusts, providing locally responsive resources for patients. A good example is in Newham, East London, where consultant urologist from Barts, Dr Frank Chinegwundoh, has been running a successful pilot, community-based walk-in centre for men with prostate cancer.

“We know from local data that African-Caribbean men are three times more likely to develop prostate cancer than white men and we know that men can be reluctant to see their GP,” he says. “This clinic, in a familiar community setting, resulted in us detecting prostate cancers earlier than might otherwise have been the case.”

Dr Powles concludes: “The beauty of London Cancer is that we have a critical mass of investigators and a large enough population to take part in clinical trials, helping us to improve choices and options in treatment. We hope to set the gold standard for prostate cancer treatment in the rest of the country.”