A new year and a bright hope for personalised medicine, but what about the quality of cancer patient care?



    Principal Lecturer and Honorary Reader in Cancer Care
    1. England Centre for Practice Development, Department of Nursing and Applied Clinical Sciences, Canterbury Christ Church University, United Kingdom
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Principal Lecturer and Honorary Reader in Cancer Care, England Centre for Practice Development, Department of Nursing and Applied Clinical Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1QU, United Kingdom (e-mail: steve.oconnor@canterbury.ac.uk)

A recent decision by the government of the United Kingdom to allocate £100 million to fund the genetic sequencing of up to 100,000 people with cancer and rare diseases over the next three to five years is hugely significant, as it will be the first time that the DNA sequencing of a sizeable proportion of any country's population has been conducted for the purposes of medical research. It is hoped that the exercise will lead to the development of new targeted therapies for an additional number of cancers than those such as breast cancer, where associations between specific gene mutations have led to the testing of individual patients for Her2 receptor proteins, and has already led to significant improvements in the management of the many separate diseases now identified under that broad nomenclature. It is hoped that mapping the genomic sequence of these cancer patients will yield further clues as to the genetic basis of many more types of cancer, and in the Prime Minister's words, lead to ‘better tests, better drugs and above all, better care’.

No one can doubt the benefit which a database of this size and statistical power would have in furthering our understanding of the 200 or so different cancers likely to affect many of us at some time in our lives. The mapping of the more than three billion base pairs in every human genome multiplied many thousands of times over offers endless possibilities for the discovery of new associations between our genetic make-up, the likelihood of our developing cancer and now, our chances of surviving that cancer with both current therapies and those yet to be developed as a result of the work. The announcement heralds the most significant step yet towards the development of ‘personalised medicine’ for patients whose cancers demonstrate specific genetic profiles, although the project is by no means unique. A study already being conducted by the UK cancer charity Cancer Research UK aims to map the key mutations found in 9,000 patients with melanoma, breast, bowel, prostate, lung and ovarian cancers, so in effect, the only difference in the government's proposals is the scale and ambition of the endeavour.

Whilst welcoming news which may well herald a ‘brave new world’ for those likely to be affected by cancer in the future, one must be wary of associating the term ‘personalised medicine’ with ‘personalised care’; and the emphasis given in the initiative to the medical treatment of the disease somewhat overshadows the fact that many patients currently being treated for cancer in the UK and elsewhere still do not enjoy basic standards of care which they would undoubtedly like to receive and should. I say that with some authority having recently been a patient in an acute surgical ward within the NHS where I witnessed some appalling inadequacies in the care being delivered to one cancer patient including the refusal of night time doses of analgesia because there were insufficient qualified nurses on the ward to check the prescription, administration and stock levels of opiate drugs on the ward during two successive night shifts. These inadequacies did not only affect cancer patients of course, but I was much more sensitive to these events given my professional background and the fact that it would be unimaginable that such a request would be refused in a designated cancer unit.

I do not want to demean the importance or significance of the Government's initiative for future generations of cancer patients, but I do wonder why so little is being done to optimise the care of those currently affected by cancer; especially those treated in non-oncology settings. The news that some of the country's specialist regional cancer networks, which have led the way in improving care outcomes for cancer patients for almost two decades, are under threat because of funding shortages and cost saving reorganisations is truly dispiriting and leaves me wondering whether this brave new world of personalised medicine isn't being built upon foundations of sand. Yes, patients will always want new therapies which offer realistic opportunities for early diagnosis and cure, but when they are unwell, they also want to be cared for by adequate numbers of well-trained healthcare professionals in an appropriate care setting. Clearly, this is not always the case and the soft underbelly of cancer care is being exposed daily to more and more risk as those working within the sector are stretched yet further by financial constraints, job freezes and re-evaluations which are leading many of the country's finest and best contemplating a career change in the face of job re-banding and eventual salary reductions. The time has now come for the government to match its enthusiasm for the white heat of technology and scientific progress with a commitment to support the softer side of cancer care, and ensure that hard won improvements in care quality standards are maintained in designated cancer units and disseminated to general care settings. This is essential is those contributing to the government's latest big idea are to receive the care that they genuinely deserve!

Talking about the white heat of technology, many of you will be aware that from this issue onwards, the Journal will only be published online and will no longer be available in a hard copy format. There are many advantages in moving towards online publication only, including cost savings for those wishing to reproduce colour prints or figures which could only previously be published at additional expense to the authors. The move to online publication poses some challenges, but with this in mind, we have been proactive in expanding the scope of the editorial team, and I am delighted to welcome Dr Philip Debruyne who is a consultant in medical oncology at the Groeninge Hospital in Kortrijk, Belgium; Dr Vikki Knott, who is assistant professor of psychology at the Faculty of Health in the University of Canberra (Australia); and Dr Natalie Pattison, who is senior clinical nursing research fellow at the Royal Marsden Hospital in London as Associate Editors of the Journal. They bring with them a great wealth of clinical experience in a number of important fields, and I look forward to working with them and the existing members of the editorial team and editorial board in this New Year.

Oh … and by the way, the cancer patient I mentioned earlier did eventually receive his analgesia thanks to the interfering old busy body in the bed opposite, but should the quality of care received by cancer patients have to depend upon the advocacy of other patients? I think not, and neither should the policy makers and accountants who dictate how many (or how few) qualified staff are required to run a busy surgical ward overnight!