Blood Cancers

Maggie Throup Excerpts

Thursday 7th July 2016 Westminster Hall

[Maggie Throup (Erewash) (Con)]

It is a pleasure to serve under your chairmanship, Mr Walker. I feel I should start by making a confession: I am probably one of the few Members of Parliament who can look down a microscope at a blood sample and identify a blood cancer, whether it is a chronic or acute leukaemia, lymphoma or a myeloma. I began my working life as a biomedical scientist in haematology. All the hon. Members present will be relieved to know that the majority of blood samples we look at in a haematology lab are normal. However, it is that rare, abnormal blood sample with odd-looking white cells that has long-lasting and life-changing consequences for patients.

As we heard from the hon. Member for Strangford (Jim Shannon), blood cancers account for one in 10 of all cancers, so they are quite prevalent. So often the patient finds it hard to grasp that they have such a serious condition. Patients diagnosed with lung cancer, breast cancer or colon cancer, for example, understand the word “cancer”. But leukaemia, whether chronic, acute, myeloid or lymphoid, does not have the word “cancer” attached to it, so the move towards calling these conditions “blood cancers” may help patients and their families to come to terms with the diagnosis and focus on the need for more research and development and funding for new drugs and treatment therapies.

Stem cell transplantation is one treatment that I want to talk more about today. Just last week I visited the Anthony Nolan research labs in north London—it seemed quite strange putting on a lab coat again after so many years. Obviously technology has changed since I was in the labs, but it was still amazing to see the world-leading equipment and ground-breaking technology and all the scientific research going on behind all the new technologies being developed. The treatment being carried out there is really cutting-edge. I make no apology for using those descriptive words: we really have a gem on our doorstep. We need to sing and dance about the Anthony Nolan research labs, and there are so many more research labs throughout the whole of the UK, as well as the charities and authorities that support them.

Stem cell transplantation is a curative therapy for blood cancer. Despite the great progress that has been made in recent years, sadly one in three patients do not survive their first year after a stem cell transplant. Only half survive to five years post-transplantation, despite all the advances that are being made. Stem cell transplantation is a complex and high-risk treatment and there is an urgent need for significant improvements in transplant outcomes.

There is definitely a need for further research into stem cell transplantation to reduce the side effects of treatment and to improve the long-term survival that we really need. I believe that doing more research will lead to cost savings for the NHS, as patients will be less likely to require specialist care following transplant, but there are a number of barriers to this type of research taking place, such as inadequate research infrastructure and inadequate data collection.

Patient outcomes can be significantly improved through more research into this type of technology. I am sure that some of the current barriers to research can be overcome with Government support for improving research infrastructure. As part of that, we need to establish and really put on the map a national stem cells transplantation trials network to bring together all the data from across the country as well as the data coming to Anthony Nolan. Hopefully, that should accelerate the adoption of new treatments in clinical practice and ultimately improve patient outcomes.

Just a couple of years ago, the Anthony Nolan research labs invested in a new technology for advanced tissue typing, known as third generation sequencing—that is where it really went beyond me on my visit there. The technology allows entire genes to be sequenced in one go, and it is faster and more accurate than was previously possible. In turn, it allows for the best possible donor for patients with blood cancer, leading to better outcomes and reducing post-transplant complications such as graft-versus-host disease.

Sadly, not every patient with blood cancer is suitable for a stem cell transplant, and even if they are, a match may not be available. For some patients, a stem cell transplant is the only suitable option, one example being patients with chronic myeloid leukaemia, a condition the hon. Gentleman touched on. Some of these patients are resistant, or develop resistance during treatment, to targeted drugs called tyrosine kinase inhibitors. Resistance to those targeted drugs is a significant problem in up to a third of patients with chronic myeloid leukaemia.

These complexities only add to the need to improve access for patients to the cancer drugs fund. Chronic myeloid leukaemia patients who are resistant to tyrosine kinase inhibitors and are not suitable for stem cell transplant need a number of medicines to be available to them. Those targeted therapies treat small patient groups and as such have been difficult for NICE to evaluate because, again, we do not have the numbers to get the evidence to prove that a drug works.

The therapies have been passed to the cancer drugs fund panel for consideration, but even now access is restricted and they have only been allowed for some patients with specific mutations. As we have heard, that is contrary to decisions in Scotland and Wales. In fact, like the hon. Gentleman, I have heard of a chronic myeloid leukaemia sufferer moving to Wales to be able to access the treatment that provides his only hope of survival for a few more months and years to spend with his family.

By the nature of the condition, blood cancers are diverse, and just a small range of approved cancer drugs or treatments does not provide a solution. It therefore follows that data on the effectiveness of the drug regime on offer are limited. This situation should not prejudice those blood cancer patients whose cancer epidemiology does not permit treatment with NICE-approved drugs.

I want to finish with three asks of the Minister. First, will he support clinical research that will improve outcomes for blood cancer patients and specifically the aim of establishing a clinical trials network for stem cell transplantation? Secondly, will he ensure that the way the cancer drugs fund is administered does not put up even more barriers to blood cancer patients? Thirdly, will he ensure that the final outcomes of the accelerated access review provide a genuine speeding up of access to transformative and innovative drugs, devices and diagnostics, not just for blood cancer patients but for patients with other hard-to-treat conditions?

--- Later in debate ---

[George Freeman]

The hon. Lady makes an excellent point. I thank her for it and endorse her sentiments. In several research areas important initiatives have been taken by black and minority ethnic and other communities with particular genetic predispositions. It is important that we support those initiatives, which I very much welcome.

The Genomics England programme operates on an explicit volunteer consent model. I want to take this opportunity to reassure the House that our announcement that we are dropping the care.data programme, which most colleagues would admit was not exactly an award-winning exercise in carrying public trust and confidence in data, is by no means, and should not be mistaken for, an abandonment of our commitment to a digital NHS. We are completely committed to making sure that our NHS is fit for purpose in the 21st century, which means that, in order to fulfil the most basic contract with our users, we need to have information for individual care, for system safety and performance and for research.

Raising awareness is the central issue of the motion. I assure Members that raising awareness and improving the early diagnosis of cancer, particularly blood cancers, is a priority for the Government. We absolutely recognise that earlier diagnosis makes it more likely that patients will receive effective treatments. On average, GPs in England see fewer than eight new cancer cases per year, but many more patients present with symptoms that could be cancer. In truth, we are missing huge opportunities to harness our daily diagnostic footprint for better cancer diagnosis.

In order to continue to support GPs to identify patients whose symptoms may indicate cancer and urgently refer them as appropriate, the National Institute for Health and Care Excellence published an updated suspected cancer referral guideline in June 2015, which includes new recommendations for haematological cancers in adults and children and young people. NICE noted that more lives could be saved each year in England if GPs simply followed the new guideline, which encourages GPs to think about cancer sooner and lowers the referral threshold.

Following the publication of the updated guideline, the Royal College of General Practitioners has worked in collaboration with Cancer Research UK on a programme of regional update events for GPs, to promote the new guideline. They have also worked to develop summary referral guidelines for GPs, including by introducing an interactive desk easel for them, to enable them to adopt the guideline. The British Medical Journal has also published summaries. In addition, NHS England’s Accelerate, Co-ordinate, Evaluate—ACE—pilots are exploring new models for delivering a diagnosis more quickly and effectively, including by piloting a multi-disciplinary diagnostic centre, which we hope will be particularly effective for patients with vague or unclear symptoms.

In conjunction with the Department, NHS England and other stakeholders, Public Health England currently runs the Be Clear on Cancer campaigns, which are designed to raise the public’s awareness of specific cancer symptoms and encourage people with those symptoms to go to the doctor at an earlier stage, when cancer is more treatable. Mr Walker, I know that you are a great champion of male health issues and have worked against stigma in health, and it is very often men who are slow to present and who tend to feel the stigma and take the traditional view, saying, “I’ll only go when I have a real problem.” The enlightened fairer sex tends to go to the doctor quicker. It is important that we remind men to be quick to go to the doctor.

[Maggie Throup]

The Minister is right to say that there are some really good promotional campaigns that raise the profile of different healthcare issues. The campaign to detect strokes early on, Act F.A.S.T., was a good one. Some of the other campaigns, such as those to raise awareness about lung and colon cancer, are also really good, but the hidden nature of blood cancers makes things harder. Does the Minister agree that we should try to raise the profile of the symptoms?

[George Freeman]

I completely agree with my hon. Friend. As she has made clear, and as I repeated earlier, it is tricky because the symptoms are not always straightforward or simple. It is often not a lump or something that is easily detectable, and the symptoms can easily be confused with those of other conditions that many of us might all too easily brush off and dismiss as the result of tiredness, fatigue and the general pressures of modern life. It is important that people recognise the symptoms. The all-party group and this debate will help to underline the importance of being aware of the early symptoms.

So far there have been 11 national Be Clear on Cancer campaigns covering seven types of cancer, and a national respiratory symptoms campaign will run from July to October this year to raise awareness of lung disease. I shall obviously ensure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) is aware of this debate and will make clear to her the cross-party support for greater awareness of blood cancers.