An interview with Prof Mark Lawler & Prof William Gallagher
Welcome to the medical independent innovation in healthcare podcast series, where we explore the advances that are transforming Irish healthcare and the innovative minds behind them. From cutting edge technologies to groundbreaking research to new models of care, Ireland is at the forefront of medical innovation. Our guests are leading figures in the Irish and international health care who are revolutionizing the way patients are being treated. So whether you're a healthcare professional, a patient, or simply curious about the latest developments in Irish medicine, join us for an engaging and informative discussion.
Speaker 2:Hello, and welcome to the latest episode of the Medical Independent Innovation and Health Care podcast series. I'm your host, Priscilla Lynch, clinical editor of the Medical Independent. Joining me in this episode is professor William Gallaher, co lead of the All Island Cancer Research Institute and professor of cancer biology in the UCD School of Biomedical Science, and professor Mark Lawler, associate professor of digital health at the faculty of medicine, Queen's University Belfast, and co lead of the All Ireland Cancer Research Institute. Thank you both for joining me, in this special episode. We're going to be talking about the development of the All Island Cancer Research Institute and about how you both became involved with the initiative.
Speaker 2:So first of all, I'm going to ask both of you, why in particular did you choose oncology, as your specialist area?
Speaker 3:So so first of all, Priscilla, thanks very much for the opportunity to chat. So my start in cancer research actually came through Joe Duffy. Now not the, the famous radio, disc jockey, Joe Duffy, but an actual hardworking biochemist working in Saint Vincent's Hospital. And he was essentially doing research. Obviously, he had a full time job as a biochemist in the hospital, but he did research, off his own back.
Speaker 3:And he probably was one of the most well published cancer researchers breast cancer researchers in Ireland. And I suppose I had an opportunity as a well, I was a science student in UCD, and during 3rd year, I had an opportunity to do a collect an undergraduate project in Vincent's with him. And that really kick started my whole interest in cancer research. That's over 30 years ago, and I've kinda kept that interest, in cancer research since then. So that was why I was bitten by the bug by that experience as an undergraduate.
Speaker 2:And how about yourself, professor Lawler?
Speaker 4:Yeah. Priscilla, just like Liam said, also influenced by a number of mentors. And first of all, Peter Humphries, who was a geneticist. And I started my undergraduate project with him, and he had just come to to Trinity College Dublin where I was then, ironically, from Queens, which is where I am now. And, I was just lucky that it was the right time in relation.
Speaker 4:He just arrived. I was interested in cancer. He'd done a lot of work in cancer at that time, so it was a natural, decision to first do a research project with him and then start my PhD. I was then lucky that he then met with a professor of hematology called Sean McCann. And so that sort of started my interest in, at that time, leukemia, although I don't work in that area anymore, but that was sort of the start.
Speaker 4:And then I I suppose the other mentor that really sort of has influenced my life in in science was Patty Johnson. And that's the reason I'm here in Belfast, and we may cover that slightly later on in the podcast. But, he was my sort of third mentor if you like, and he persuaded me, to come to Queen's and Belfast initially as a visiting professor. And then, subsequently, I got a job here, and I've been here for the last 11 years.
Speaker 2:Both of you have an array of titles which showcase your long established, careers in research in oncology. But from talking to both of you previously, it's all about, you know, putting that research to work for the benefit of patients. And this project that you're both involved with, the All Island Cancer Research Institute, it's a really interesting initiative, a north and south initiative, something that's very unique, very special. And, Mark, you were really involved with this institute long before even it was in its current format. So can perhaps you tell me a bit about the history of how it came about and how it's developed into what it is today?
Speaker 4:No. Absolutely. So this all started 25 years ago, with the, development of the Ireland, Northern Ireland, US National Cancer Institute Cancer Consortium. So, actually, up in Stormont, there was a memorandum of understanding signed by the 2 ministers for health at the time and the director of human health services at the, US. And that's really started an initiative that has grown and flourished over that period of time.
Speaker 4:And it's allowed, for example, cancer clinical trials, 35,000 patients to be on cancer clinical trials on the island of Ireland. It's allowed us to enhance research between Ireland and Northern Ireland and the NCI, a 550% increase in joint publications, but not only the sort of number of publications, but also the quality has greatly increased. So it was really a great initiative, and that initiative was inspired by, my 3rd mentor, as I said, Patty Johnson, because he had been at the National Cancer Institute in Washington and saw the opportunity when he came back to Belfast to really set up a unique partnership. And that partnership has just grown over that 25 year period, and we're celebrating and that partnership this year, which has been great with a number of different events, including a recent, forum that we had in Farmly. And so it's been really a and, you know, a a a a journey, if you like, but a really positive journey for patients on the island of Ireland.
Speaker 2:And, obviously, that US input is crucial as well to the success and to development and the uniqueness of this particular initiative. And that's something that hasn't faded away into the background. It's it's stayed there, and, what we're going to discuss later in the podcast is gonna showcase that. Professor Gallagher, can you tell me as well about your, involvement in the project and and shaping it?
Speaker 3:Yeah. So even early on in my career, I saw what was going on in terms of I'm slightly more junior than Mark, not not too much. I had seen what was going on there in terms of that partnership, that tripart apartheid partnership between Ireland, Northern Ireland, USNCI. And I suppose, I suppose what I was critically interested in, what was happening on the island of Ireland in terms of encouraging people to come together, I suppose, for common interest to combat cancer. And I suppose I'd been involved in leading or co leading various different large scale cancer research programs.
Speaker 3:So one particular program, which I had the pleasure of leading, was called Breast Predict, so where we assembled all of the breast cancer researchers, now in this case, in Ireland, not in Northern Ireland per se, across the country where we had surgeons, oncologists, people working in the labs, mathematical scientists, all working together towards a common purpose. This was funded exclusively by the Irish Cancer Society for a 6 year period. And it was great. We had a lot of, great work, for example, big impact in terms of not just publications, but also at a at a clinical level in terms of new clinical trials. But what was frustrating to me was stop start nature in terms of, projects.
Speaker 3:You know? Like, cancer doesn't think in its 3 to 5 year cycle. So, ultimately, when we're trying to tackle cancer, we need to have a long term perspective. And, I suppose the trigger for that happened, I think, around 2018. I had a conversation.
Speaker 3:I was sitting beside I was I was involved in a patient voice in cancer research event driven by my good colleague, professor Amanda McCann, where we're encouraging researchers to interact with patient partners. And I was sitting beside someone who was a a chap called Kieran Briscoe, who was involved in Family Carers Ireland who had, you know, family members affected by cancer. And I suppose I was telling him what I wanted to do in terms of this broader picture in terms of cancer research on the entire island. And, he had the expertise, I guess, in terms of that political engagement piece, which was critically important. And we we kind of thought about what was our strategy in terms of going forward.
Speaker 3:And then, in conversation, we brought Mark in to really look at how do we do it, really provide that kind of vision for integration of cancer research across the entire island. And then in 2020, we actually got nominated representatives for 10 academic institutions across the entire island, but also importantly, other stakeholders from, say, for example, National Cancer Control Programme, different cancer charities, industry representatives, patient partners, other clinical trials groups. So it was important not just that we stay within our, you you know, ivory towers of the academic arena, but also broaden it. And I suppose what we did then is we this is kinda like a grassroots effort where we asked for ideas from the community. We asked people, what what were you interested in?
Speaker 3:What do you want to do? And we got a huge amount of really exciting ideas. I suppose our effort was to try to channel some of those ideas towards specific projects. And what was great, just soon after we did that, an opportunity came under, essentially, what's called the shared island unit. This was an initiative driven by Department of Antishuk for funding, not just for, you know, this was a particular pot of money for research, but it's a more broader perspective of initiatives to integrate what's happening in terms of Ireland and Northern Ireland.
Speaker 3:And we essentially bid it very strategically for that program, and we were delighted to be very successful. This was all aspects of science, all aspects of humanities. And we essentially got 1 third of the funding under that program for North South Cancer Research Projects. And so one project that myself and Mark lead, it's like a demonstrator project where we have, 10 PhD students, 10 postdoctoral fellows across the 10 academic institutions, but working together, okay, across institutionally in the area of precision cancer medicine. And then we have 2 other projects.
Speaker 3:1, again, Mark is involved with, and he'll probably talk about it later, the area of, data, area of ehealth and digital health, and another project, which is led by, professor Lorraine O'Driscoll in Trinity and Paul Mullen in Queens in a very exciting area of liquid biopsy. Can we find this magic kind of needle in the haystack in blood, which is an indicator of cancer? So I suppose what we've done now is, you know, we have this groundswell of kind of interest. We've been quite successful in terms of putting some of the community together, but now we want to bring it to that next stage. That's really critically important for us to really go to that final stage of, I suppose, developing an all island virtual cancer institute that really maximal maximizes opportunities for patients, but also the broader research community.
Speaker 2:Absolutely. And cancer knows no boundaries, as we know, and Ireland is a small island. So really pooling resources, clinically and, you know, across research institutions obviously has many benefits as you've mentioned there. And there's different things we can learn from each other as well. I'm sure, Mark, you certainly do some things better in Northern Ireland and perhaps vice versa.
Speaker 4:Yeah. No. I think that's really that's sort of complementarity, and each of us bringing something to the table is really important. I mean, Northern Ireland is probably better in relation to cancer biobanking, for example, and some of the data aspects, Republic of Ireland probably better in relation to, to aspects of precision oncology. There's a precision oncology initiative, that's been running for a number of years, led out of UCD.
Speaker 4:So I I think it's really complementary, and it's the sum of the parts. And, you know, again, sort of going back to you, you know, what you said there earlier yourselves. Not only do we know no borders, but also we don't compete against each other. We compete against our common enemy, which is cancer. And but it's been a great journey, and it's been brilliant to have a colleague such as Liam.
Speaker 4:So as as something said earlier, we're sometimes known as the Chuckle brothers when we get up on stage to talk about the initiative. But it's been a great partnership, and and that's really the key thing because personality does influence, you if you can work together, it makes it a lot easier to drive programs like these. And it's been a very exciting journey as well, which, has been great.
Speaker 3:Yeah. And I think a key part of this well, myself and Mark are probably identified as kinda so some of the drivers or key drivers behind the initiative. It's it's it's it's it's what people make of it. So we have a co leadership structure so people can take different elements out of it, and we see other groups kind of driving forward different initiatives, and we try to support that. And, it's an inclusive initiative, and that's that's key for me that, you know, certainly, we think you can it's probably easy to criticize things that you're doing.
Speaker 3:But then if you're making it if you're involved in making it, then it's it's harder to criticize it. So it's it's that inclusivity piece is critically important and that buy in from from the broader community. But also the close engagement in terms of like, we have very strong support from the National Cancer Control Programme. Aristo Ollida, who's a director, is is a really strong advocate of this programme. Because if you look at the National Cancer Strategy in Ireland, for example, there's a call for an overarching framework for cancer research.
Speaker 3:There's it's in the strategy, but we don't actually have that. We don't have a written down plan of what we're supposed to do in cancer research from fundamental discovery all the way to clinical trials. Now that doesn't mean we don't have good activity. We just don't have a written down kind of a plan, and that's part of what we're trying to do. With ACRE is define what we're good at and what's the opportunity areas and how we can actually work effectively together.
Speaker 2:I suppose one thing that really researchers have to agree on is every country can't be good at everything, and cancer is such a broad disease. Is there particular areas that you're interested in honing in and that you think that Irish researchers can bring particular benefits to?
Speaker 4:The data space is one where we feel that there's a great opportunity. Yes. There are some challenges, but it it is a great opportunity because you've got an island of Ireland with approximately 7,000,000 people on it, which is actually a good size in relation to doing data science research, and looking at ways in which you can share that data. Both Ireland and Northern Ireland are part of something which is called the International Cancer Benchmarking Partnership, which I'm privileged to chair. And that allows us to actually look at comparing data because you wanna find out how are you doing.
Speaker 4:Are you doing well? Are you doing not so well? Not to compete, but just to find out, well, what is it that would make it better in terms of survival or earlier diagnosis or whatever. I mean, a good example is Denmark, which was, down at sort of the bottom of the league table in relation to cancer outcomes if you compared several countries in Europe and, Canada and Australia. But then they realized that through the international cancer benchmarking because they saw that the data showed that they were doing poorly, but they did something about it.
Speaker 4:They went and really prioritized cancer, and then they also prioritized primary care and looking at ways in which you could diagnose cancer earlier. So it just shows you that using data can allow you to actually make a difference and make changes. And so I think that's a great opportunity. And, obviously, Lee mentioned the health hub for cancer that Hadrian Culhane from the University of Limerick and myself, co lead. And that's a good example of working together, sharing data, looking at ways in which we can really use that data most effectively, to understand more about the disease, but also to look at affecting change, be that policy change, be that early diagnosis, be that new, therapeutic approaches.
Speaker 3:Yeah. I suppose just to jump in there, Priscilla, I suppose, again, Mark kind of led on a very critical paper, published recently in, it was in Lancet Oncology Commission, which was essentially the most comprehensive analysis of cancer research across Europe, which really kind of informed, you know, provided a a lot of key recommendations. And one thing and I also have done a certain amount of analysis of what's happened in terms of what we've done well on the island of Ireland. And just recently, we've gotten some funding now from the Irish Cancer Society to actually do even further deep dive, really to provide that evidence base of what we're actually good at in terms of, you know, from a publication's point of view, but also a delivery in terms of impact in terms of care. And, you know, if we just take one example, if you look at, for example, Cork have a an amazing center focused on the microbiome, the APC center, which are really punching above its weight But some some activity in the cancer research space, but could be more, for example.
Speaker 3:And you've also got strengths of different researchers around Ireland in the area of immunology, and we saw an opportunity where you could actually converge this idea of immunology and the microbiome together. So that was one of the workshops that we've organised. We think there's, like, the if I suppose our function is to identify complementary opportunities and and and bring those stakeholders and and and researchers together.
Speaker 2:Very much so. And I think, Mark, you're obviously a very well known data champion, and, you've showcased really the benefits of of using data even during the COVID 19 pandemic when we looked at, the changing patterns and presentation of cancer, the delays, the impact on patients of not, being able to come forward to be treated and to be diagnosed. But that is something that is is large, source of frustration, professor Gallagher, obviously, in the republic because we don't have access to the data the way we should do. We are improving, but, we certainly don't have the structures that we need. And sometimes even individual units find it hard to talk to each other, not mine to try and get a picture of what's happening in real time across the country.
Speaker 3:Yeah. Like, this is this is, Mark's space, but I can have more of a general comment in terms of, I suppose, in in Ireland, we've we've had a very, very strict interpretation of the, I suppose, health research regulations when it comes to data. And, obviously, we've had challenges in terms of, obviously, you know, the hacking issues in terms of computer interface. You know, we've I've had a variety of different kinda IT related issues, but critically important is that we need a common identifier really to actually carry out both effective patient care, but also any level of high level research. But certainly Mark is is the expert in this.
Speaker 4:It's an interesting story, Priscilla, actually, because it actually started with a personal story. So at the very start of the pandemic, my uncle unfortunately passed away due to a COVID related illness. And one of my colleagues who's an oncologist in Croatia, Edward Wodoliac, was reaching out to me with to sympathize with me on my loss, but he then said something that really worried me. He said in Croatia at that stage, which is just at the start of the pandemic, people were fearing a COVID diagnosis worse than a cancer diagnosis. And so we thought about that and we said, anecdotally, we'd heard a couple of people saying that but no real evidence, and that prompted us to do the work in relation to looking at the impact of COVID and lockdowns on cancer patients and cancer services.
Speaker 4:And what we found initially, we did it in the UK. Just to summarize, you know, 7 out of 10 people with a suspicion of cancer, they weren't seeing their GP or weren't getting referred on. 4 to 10 cancer patients weren't getting their chemotherapy in time. And that led then to a European study, which showed that there's a 100,000,000, cancer screening tests were not performed and 1,000,000 diagnoses were probably missed. So, you know, the unfortunately, the impact of the COVID pandemic outside COVID has actually been significant and potentially more significant.
Speaker 4:I mean, that could take a decade for us to turn that around. But the reason why we were able to do it so quickly was we were able to get access to near real time data. And so, again, Priscilla definitely would agree with you that that ability to access because you wanna know what's happening in the here and now, not what's happened a year ago or 6 months ago because you can't make decisions unless you have, you know, accurate but also timely data.
Speaker 2:Absolutely. And and that is something I think researchers are pushing for more, in the republic and especially with trying to roll out an electronic health care record. And then obviously given your work, how can we get our electronic, care record to speak to yours, in Northern Ireland and to make sure that you do have access to that data? Because really, isn't that that's going to be the key from, from so many different strands of research, whether it's into prevention, diagnosis, and treatment, having access to patient data, large scale datasets, been able to do those studies and really see how how you can help patients at the end of the day because that's what it's really all about.
Speaker 4:Yeah. No. Completely. And one of the things we're looking at at the moment is to try and set up secure data environments to do work between the north and the south and in terms of your sharing data within a safe environment so that we can actually do those sort of comparisons between north and south, but also contribute to the international research effort as well by, you know, participating in research studies like the International Cancer Benchmarking Partnership and other ones as well. But the key is being able to get that data in in near real time, being able to use.
Speaker 4:And and and the interesting thing is if you talk to patients, they want to see use the data. In fact, they're often surprised why isn't it being used. So, you know, we're we're really sort of, you know, sort of tying our own hands behind our back in relation to particularly in the Republic of Ireland, and I've gone on about this in terms of why don't you get a patient rec you know, the unique patient identifier. I mean, there is some movement forward on that, so hopefully that happens more quickly than it has to date.
Speaker 3:And I suppose there's a slight disconnect, obviously, because obviously Ireland is well known for its, you know, I suppose, sophisticated industry ecosystem there of ICT, for example. There's huge opportunities. We've just completed a body of work funded by Intertrade Ireland and the kind of industry ecosystem analysis, really looking at asking the question, who are who are the companies on the island of Ireland which are carrying out activity in the oncology space, but also allied digital health? There's some really exciting arrange range of companies out out there, which are, for example, leveraging the use of AI approaches for pathology or for, you know, clinical trial design or kind of care. But it would be very unfortunate if we can't use those particular technologies.
Speaker 3:It might be developed in our on the island of Ireland, but if we can't use them on our own island, that would be quite unfortunate. So I think we have to actually be able to be ready to, I suppose, act as a kind of test case example. But for that, we need certain issues of particularly in in Ireland.
Speaker 2:And that is something really that is key is to, in ACRE, not working in silos. So not only are you working north and south, you're trying to find out what else is happening, that is in this sphere. How can that connect into your research? And, obviously, as well, at a European level and at a US level is something that we're going explore as well, that you're not just working here in isolation. You're looking at the the bigger picture and what can we learn, you know, on on the the wider scale.
Speaker 3:So I I suppose one one thing that's was which was great last year, we so ACRI, was it was joined in with the National Cancer Control Program as part of a big EU grant called ECCOS. So this is essentially a large scale programme funded under the EU Cancer Missions, a programme to a large scale funding mechanism focused on cancer driven by the EU. And, essentially, this particular programme is going to establish what what are called national cancer mission hubs in each EU member state, but also an associated network. So what's a national cancer mission hub? Really, it's I suppose it's a it's an ACRI like construct, you know, it's an organisation or a loose organisation that actually improves, I suppose, participation at a European level, but also better connects research with policy.
Speaker 3:You know, there's no point in actually carrying out research that's disconnected from policy. So having that close association between what's going on in the research level and what's going on in the policy side. And for example, you know, last September, we had a great day, actually, where we essentially, a day focused on who has been funded at a European level for cancer research programs or care programs or yeah. And we we essentially, it was the EU Cancer Mission Day in the Herbert Park. And it was an amazing story where we have all of these really exciting new potential screening, programs coming on on stream in terms of demonstrators in prostate cancer, lung cancer, gastric cancer.
Speaker 3:They've been funded under European programs, and what's important is they're funding the demonstration of these new screening programmes, but also Ireland is involved in that demonstrator such that, for example, if they're successful, then they're the early adopters of those particular approaches. So I think the whole idea is that we want to get more involved. We need to be more organised to be involved, and that's where something like ACRE can be involved.
Speaker 2:And, obviously, that's very important for Northern Ireland as well, given the implications of Brexit, professor Lauder.
Speaker 4:Yeah. No. One of the great things is, obviously, now we're back in Horizon Europe and in relation to funding, but it's not just the funding that's important. It's the actual interactions. The funding helps the interactions, obviously, but it's so so one of the things we're really delighted.
Speaker 4:In fact, I've just been out of meeting earlier on today in terms of, you know, planning how we will, approach, some of the funding calls in Horizon Europe. And and, obviously, you know, what makes perfect sense is the ideal partner is just down the road and in relation to you know, so one of the things we're looking at is trying to enhance more, Ireland, Northern Ireland collaborations as part of bigger collaborations to look at successful funding through Horizon Europe and the particularly the Cancer Mission program, which obviously is the only health program that specifically mission that's about, you know, a health condition. So we're really looking at ways in which we can can drive that agenda as well.
Speaker 2:And, recently, the the 10th anniversary of the European Cancer Patient's Bill of Rights, happened. That was launched on World Cancer Day in 2014, and that was a catalyst for change and a charter for action for those affected by cancer in Europe. And, Mark, I know you've written about this and, obviously, you've been involved in this. And how has that kind of, I suppose, informed your work and the work of ACRE as well?
Speaker 4:Yeah. Very much so. That's the reason I came to Belfast, actually. That that was the project. It was a very specific project that Paddy Johnson asked me to work on in terms of looking at cancer inequality.
Speaker 4:So at the time, it was the largest cancer inequalities analysis that had been performed in Europe. And, really, it shocked us what we saw, and that led to us then developing the European Cancer Patient Bill of Rights. And what's been great about the Bill of Rights is it's really acted as a catalyst of change right across Europe, but it's also led to us developing a European code of cancer practice, with the European Cancer Organization. And that's been really important because it's essentially identified the 10 things that cancer patients should expect from their, health system. And so looking at not just things in relation to diagnosis, but also reintegration into society.
Speaker 4:You know, so a whole range of different things. Research is very much an important part of that. So that's been critical because it's that's really gained sort of a European wide acceptance. Cancer patients are using it in in relation to, you know, answering asking those questions of their health system. So it's been really effective and very practical patient orientated, but it started with a study to look at identifying the problem.
Speaker 4:So, again, data is really important. It gives you the intelligence to identify what the problem is and then informs then how you deal with that problem. But, yeah, well, I can remember the the one challenge I remember in terms of actually launching the European Conservation Bill of Rights in the European Parliament. I was presuming we would be launching in Brussels, but one in every 4 weeks, the European Parliament goes to Strasbourg. Strasbourg.
Speaker 4:I can tell you trying to get 50 people to Strasbourg, to launch something is not easy. The flights are all over the place to try and get there. So that was one of the downsides of launching the European Parliament.
Speaker 2:Well, one one interesting thing really that's come from the charter, I think, and from what I I get a sense of from a lot of the, research and the the press releases that I I get from the European Union and the European Commission is the in kind of the increasing focus on prevention. Because when we talk about cancer research, I know it's very important about cancer trials, about treatment, but also even, professor Gallagher as well, in your research, how do we predict who gets cancer? How do we prevent that? And you you mentioned there about screening programs as well. And currently, we we only test for a small amount of cancers, you know, where there is that evidence base there, the strong evidence base for a screening program, but there has been increased cold, say, in particular in lung cancer.
Speaker 2:So that it's it's obviously an exciting time and a focus as well that's important to ACRI about prevention, isn't that it?
Speaker 3:Yeah. And I think I I think the challenge with looking at cancer prevention is you need a long term perspective. So, for example, a lot of the big prevention studies which have taken place at the European level have been driven by the Scandinavians, for example, because they have a long term perspective. They have a lot of funding driven by large scale foundations, which allow 20 to 30 year perspective. Now what's interesting is that Ireland is a partner within the International Agency For Research Against Cancer, which is in Lyon.
Speaker 3:So it's, and, actually, I was the scientific representative from Ireland for about 3 years, just up to about 2 years ago. And it's an amazing organization in terms of that that by ARC, really a big focus is really on this area of cancer prevention and then looking at risk factors. What's very interesting, given the focus of a a meeting that just just just took place, we'll probably talk about later, the Euro American form of lung cancer, one of the focuses on lung cancer. And, obviously, you know, we know one of the big triggers for lung cancer is smoking. That's obvious.
Speaker 3:One of the kind of key things that's come out is a refocus on area of pollution, environmental pollution, as a driver, as a promoter of lung cancer. And that's that's essentially driven by work from, clinician scientists in in the UK called, Charles Swanton, who published a very significant paper in Nature a couple of years ago where he looked at microparticulates in the environment as a kind of this kind of key driver, you know, that, you know, we have mutations all the way in our body, but this is really almost like an accelerant. These these, these microparticles that return heavy polluted cities. And so the whole area of kind of environmental impacts as drivers is very important, because often we focus on, you know, which is important diet, but these other external factors, which we need to kind of consider at a societal level. So, currently, from an ACRE point of view, yeah, cancer prevention is critically important, but we also need to have the infrastructure to carry out prevention research and also do prevention trials.
Speaker 3:And that takes a long term committed perspective, and that's back to my original point that you can't really fund that in a 3 to 5 year cycle. You need a 10 or 20 year kind of landscape.
Speaker 2:That is fascinating, isn't it? Because I've I've heard a lot about, the impact on respiratory health, of pollution. But now, as you said, we're beginning to rise its longer term impact on cancer as well. And but that is something that takes a lot of work, a lot of research, a lot of data. But as an Ireland, obviously, Ireland is very well poised there to to look at the the pollution levels in Ireland and to track, you know, the the levels of cancer.
Speaker 2:That's an area that is is obviously ripe for research.
Speaker 4:Yeah. No. Absolutely. And and, you know, again, looking at ways in which we can work together with other disciplines, which is really important in terms of looking at that public health disciplines, but also, one of the things we've been interested in is is developing approaches where we, you know, bring together computer scientists, biologists, And together, we have a a program called momentum one zero, which is part of the Belfast region city and growth deals where we wanna apply secure connected intelligence both in the health and the agri food space. That's sort of one health space if you like.
Speaker 4:Because I think we're gonna have to think about disease and well-being completely differently over the next 10 to 20 years. We're probably gonna move away from the hospital approach to a more in the community approach. So we need to have sort of different algorithms, and that's why, you know, we we're very much an open church. We welcome anybody to work with us. They don't have to be cancer researchers, you know, because we see that there are opportunities, for interdisciplinary research that will bring new solutions that we need to address complex issues like, you know, the interplay between the environment and health, for example.
Speaker 2:And, obviously, quality of access is going to be important as well. When we're talking about the the rollout of of new screening programs perhaps for lung cancer, I'm sure you both agree that it'll be very important that patients both north and south have access to these screening
Speaker 3:actually, interesting. One of the programs in lung cancer, it's, the Irish participation in that is driven by, professor George Gnaideau and professor Patrick Redmond out of the Weill College of Surgeons Beaumont Hospital. And they're specifically their part is to look at how do we, I suppose, tackle marginalised communities or underrepresented communities in terms of those screening programmes. Because, again, if you're if you're always just targeting the worried well or individuals who are certain socioeconomic demographic, you're not really gonna tackle the full issue in terms of, the requirement. So that's that's how these EU programmes can actually be useful because you can actually find funding and demonstrate it.
Speaker 3:And that's a key part of the overall European mission, being able to get in there and actually target and identify new tailored approaches based on different communities or different groups. Like, again, one of our kind of one of our colleagues on the ACRE side, professor Michael Carron in Galway, is quite passionate about kind of regional differences in terms of uneven the island in in Ireland, in terms of, I suppose, the different differences in terms of access regionally to care. Because, obviously, if you look at the Galway region and that whole whole service region, it's a huge geographic region and multiple different communities, and there's kind of a a spatial kind of issue in terms of people having to physically you know, it takes a long time for them to go over to different parts of of of that part of Ireland. Whereas, obviously, I'm I live in Dublin. So, you know, it's easy for me to be able to get access to almost immediate access to care.
Speaker 3:And so we have these kind of spatial differences that need to be addressed, but also the changing nature of how cancer care is delivered. We obviously have this, you know, which I think is has been a good thing in terms of centralization of cancer services. And we probably have further centralization and specialization in terms of cell therapies, but also you still have to be able to offer things to people who actually live at a different part of the island. And so that that that that level of sophistication needs to be put into place.
Speaker 4:Yeah. One of the things we did, Priscilla, recently was actually developed a European code of cancer practice, particularly for rural areas, because there is that rural, rural, urban divide in relation to cancer care. And we sometimes talk about the rural deserts in relation to, cancer and and other diseases, but it seems to be sort of more prominent in cancer. And and it's on its you know, there's also sort of coastal regions as well. So, you know, that's why it's really important to look at your environment as well as your so it's nature and nurture if we go back to the old saying.
Speaker 2:That's very interesting because I I know looking at screening, for example, it it can be bought into communities, and that is happening actually with some of the screening programs, bringing screening locally to people in their communities to encourage them to to take it up. And also certain cancer services can be delivered locally. I know, obviously, we had a huge reconfiguration in Ireland for good reason. But there are some things such as chemotherapy that can be delivered locally, which is very beneficial to to patients. But sometimes there can be a bit of a resistance to that, even though, as you said, the way to go is trying to bring as much care into the community, uncomplicated care.
Speaker 4:Yeah.
Speaker 2:And that can include some cancer care.
Speaker 4:Yeah. No. Absolutely. And we obviously had to do that during COVID, and we and we've learned from that. I mean, one of the things that I've been sort of advocating is let's not forget the good lessons we learned from COVID in terms of things that we we actually adopted and did well.
Speaker 4:And it does worry me slightly that in certainly, certain certain organizations are sort of suggesting, oh, well, we just did that because we have to, and that's now go back to what we were doing. And, actually, what we were doing was completely inappropriate in the modern age. And that's certainly looking at ways in which we can learn from the obviously, we've had huge challenges and I'm not in any way belittling that, but we also learned how to do things differently. So we shouldn't then just be going back to sort of just because we did it that way before means it's the right way. I think we we we learned how to be really innovative.
Speaker 4:And the other thing I think we learned very clearly was that you cannot deliver better health without research because we would not have got any of the COVID vaccines or anything like that except for the research that was done. And similarly in cancer, we now know we've proved through what Lee mentioned earlier in relation to the cancer ground shot and that people who are treated in research active hospitals have better outcomes than those who are not. So research is not a luxury. It's actually a necessary component of 21st century cancer care.
Speaker 3:Yeah. And I suppose COVID, like, people are energized. It was a new thing. There was an impetus. But, like, you know, the the cancer burden, like, 1 in 2 people will get cancer during their lifetime.
Speaker 3:Okay? It's particularly in Ireland, on the island of Ireland. So it's only going to increase. And, you know, ultimately, now on the on the positive side, obviously, we've made huge huge developments in terms of diagnostics and treatments, and there's a huge increase in the number of people who have kinda gone through with cancer experience coming out the other side. But sometimes they're left with various different issues in terms of anxiety, work related issues.
Speaker 3:I suppose one of the opportunity areas that we're kinda diss a bit disappointed about is that we don't have a big program that actually brings, the area of cancer survivorship and quality of life issues together. And that's an area that, certainly, I'm passionate about trying to actually drive forward, because we've done pretty well in in in our neck of the woods, which is the laboratory sciences, still somewhere to go. But that whole area, there's some very good individual programmes, but there's still an opportunity and requirement, I think, for a bigger program to bring and maximize what's going on and provide opportunities for people to really address those critical issues. I'll give you one concrete example. I have a family member who went who gone through a a cancer ex experience left with severe insomnia and, you know, tried different things to to to address that.
Speaker 3:But a colleague of mine, you know, just going to a cancer symposium, it was a nocture ongoing trial for a sleep, kinda app, you know, as opposed cognitive behavioral therapy approach, very simple trial that you could participate in. It's not talking it's not talking about a new drug. It's essentially an app that can help people sleep. But being able to sleep is probably one of the most significant things for certain people after a after a cancer experience when they've gone through it and, has dramatic impacts on quality of life. But, you know, it's kinda not easy.
Speaker 3:It's it's not easy to get that type of activity funded. It's not, now I suppose you can turn it on its head, and you can essentially say, look. You may not get a nature paper on it. Right? But you'll have a dramatic impact in terms of of of of lifestyle, but also there's opportunities from an economic impact in terms of because you can also incentivize companies to develop these types of apps and solutions.
Speaker 3:So I think we need to kinda just think more broadly about how we how we think about addressing cancer and how research can be used to advance, I suppose, ensure that people live better and longer lives after their cancer diagnosis. It's as simple as that.
Speaker 2:That's very interesting that you mentioned survivorship there because that is an neglected area. How do we measure cancer outcomes if we look at 5 year survival? But do we look look enough at quality of life and the impact of cancer treatment on people's bodies and, their quality of life afterwards. We're realizing now that sometimes that aggressive cancer treatment doesn't really lead to, you know, a better life, afterwards? So that is, again, an area that is ripe for further research.
Speaker 2:And, again, it's about getting that data, though, isn't it?
Speaker 4:An area that we've we've very much focused on because, published a paper there recently in relation to really developing a survivorship plan for Europe because there isn't a survivorship plan for Europe in relation to cancer. And one of the things we've sort of been saying is that we really need to look at ways in which we can capture that type of data, be it psychosocial data, be it physical data in relation to the effects of treatment. Because there are 20,000,000, cancer survivors in Europe, and, certainly, I don't feel that we're doing enough for those 20,000,000. We need to be quite innovative in terms of how we you know, in terms of collecting data from apps, etcetera, and, you know, and and looking at ways in which we can really deliver for those people who are surviving accounts and living with and beyond cancer because we're we're getting better at treating it, but that's the the the the sort of side thing is that we're then obviously gonna have more people who could potentially have either physical or psychological So we need to be providing that level of service, and that gets back to, you know, sort of what we were saying earlier about, you know, because that the law of that will be done in the community.
Speaker 4:And the other thing is, obviously, COVID also had the impact on on on, cancer doctors and allied health care professionals. I mean, one of the things we found was that 4 to 10 cancer health care professionals were burned out, but more importantly, 3 out of 10 had signs of clinical depression. And so as well as the patients, it's also the actual, medical practitioner we need to look after as well.
Speaker 2:I think you're really bringing it back there to, you know, that there is such a broad, scope of areas where we need to know more about in relation to cancer. And it doesn't always have to be very complicated or very expensive. It doesn't have to be about precision medicine, about genomics. It's very much, again, as you said about how how do those working in oncology, how do those patients, experience experience oncology? How how do they feel?
Speaker 2:What is the impact on their on their lives afterwards, whether it's from the disease or the side effects? How do those working, in cancer care? How do we ensure that they have sustainability in their careers, that they don't feel burnt out, that they can really give the best to patients? So there's a lot of areas there. As you said What we
Speaker 4:did 2 weeks ago was in in the Mansion House in London. We launched a cancer workforce fund through the European Cancer Organization and to look at ways in which we can provide a low level of funding initially, but seed projects to look at exactly those issues and the other, for example, digital solutions that we can put in place that can help. Are there other ways in which we can work with, cancer professionals? So very keen on looking at ways in which we can do that. And as I said, we've we've created a fund to to do just that and to look at trying to find tangible solutions that will actually make a difference for cancer health professionals.
Speaker 2:And I know, professor Gallagher, you're very involved with getting the patient voice, you know, into what what focuses that you're you're looking at in cancer and and how they can become more involved even with your work with the cancer choir. If you can tell us a bit about, I suppose, how you reach out to those communities. I see that you're a lot online even across Twitter, and you're accessible. So you're not away in this big glass institution. It's a it's very, you know, forbidding looking.
Speaker 2:You're out there. You're reaching out to people. You you want to listen to them.
Speaker 3:Yeah. I I find it very interesting because, again, yeah, I kinda keen to get out outside university and and and interact with people. And I suppose one of our most recent events happened just before and in the lead up to the Christmas Christmas shopping. Now, normally, I'm not great shoppers. I don't like going shopping, but I was in Dundrum Town Centre and, on the ground floor, and I was there as part of an exhibition that I've been working with, Vincent Devine, who's a fine artist who painted the portrait of Vicky Phelan, the triptych portrait.
Speaker 3:And And so I went to the, unveiling of that and on a couple of years back in Mooncoin where where Vicky was living at the time, and, I I our parents were there. And, ultimately, I was struck by it in terms of its ability to convey a message, kinda tell a story. And I said, okay. I need to work with this guy in terms of conveying a message in terms of cancer research. So I interact with him and said, look.
Speaker 3:We we start working with us for with our cancer researchers in our institute, but also some patients to tell their story, to tell the story of cancer research and tell the story of patient's story. And that kind of exploded into, essentially, 5 paintings. It was essentially a a play on the Vitruvian Man by Leonardo da Vinci. We call it the Vitruvian. It's an androgynous figure, and we built all of these different kinds of research stories in there as a visual kind of metaphor.
Speaker 3:But also, we built in patient narratives. And what was amazing was when we were displaying this and the other works, it's just it's just random conversations you have with people. So just, you know, as long as you say to people, we're not selling anything. Okay? We're just just showing a painting.
Speaker 3:The stories, every single person I talked to had a cancer story. Every single person. Every everyone. So look. Anyway, that's just an example of of our one of our more recent projects, in that space.
Speaker 2:It's a really interesting, project, and it just shows really about research. People's real stories can really influence, you know, what, what you focus on and what you look at and what you realize is actually important. And Mark, I suppose from your own perspective as well, you're very keen on, you know, making research more accessible and bringing it into communities and to patients on the ground.
Speaker 4:Yeah. No. We're really lucky in Northern Ireland. We have the Northern Ireland Cancer Research Consumer Forum. So it's a group of patients and patient advocates but specifically focusing on research.
Speaker 4:It's really important. One of the things we've done is very much in terms of, an initiative called Datacom, which is the UK's health data research hub for cancer. Cancer patients not only are at the center of that in theory, but absolutely very much in practice. So, for example, they were involved in the original writing of the grants that led to the development of Datacam. They're involved in the management committee, the steering group, but also they're involved in any conversation we have with partners, either academic partners or industry partners.
Speaker 4:So they're in the room, and that's what we the way we want it. And so they actively participate rather than possibly receive. And and what's really interesting is that some of the conversation we've had, for example, with industry have come back to us and said, actually, having the patient in the room was much better because we actually ended up developing something much more patient centered, patient approved, and actually a better study than what we came up with in at the start. So that's real cocreation if you like. And both Lima and myself are big into that idea of, you know, not rubber stamping or saying, oh, patient advocates involved in this, but real cocreation where they're working together with us hand in glove.
Speaker 4:And and that's been really, informative for us and humbling for us. And one of the quotes I love is from, Pete Wheatstone, who's the chair of our PPE committee. He said, not only are we empowered, but we feel empowered. That sort of made me feel, well, we must be doing something right.
Speaker 2:That's great to hear. And, I suppose moving from on the ground in the community to maybe the bigger stage, you were both part of the ACRE delegation that was, in the US in March, where you met members of the US Congress on Capitol Hill in Washington, and, spoke to the US Congressional Cancer Caucus and explained to them the work of ACRE and and the benefits that it's bought over its 25 years.
Speaker 3:Yeah. That was an unbelievable opportunity, and I'd like to pay tribute to, again, Kieran Briscoe. He's he's I think he was probably spent about 2 years working on this at some different levels in terms of engagement. And, again, that US Ireland connection is critically important. Like, one of the untold stories is it was amazing.
Speaker 3:Like, we probably I don't know exactly. We probably have about 80 medical oncologists in Ireland. Approximately, over half of them have been trained in the top 5, cancer centers in the US. Right? Nowhere else in the world like that has an enriched population of such highly trained individuals on the, cancer treating side.
Speaker 3:And so that we have and, also, we have strong footprints of people who've gone and stayed there, like Eileen O'Reilly, who won the Birkett medal in Trinity there a couple years back in Memorial Sloan Kettering. So we have these ties both on the clinical side, but also probably at a also at a preclinical side. And so we've had, obviously, the tripartite program. We have various different links. And I suppose what we were trying to do with that particular interaction on Capitol Hill was obviously tell that story, but also tell that what we've been doing in terms of this cross border story, in terms of partnership across boundaries.
Speaker 3:Cancer is a kind of neutral topic that can break down things, that can be up that can go beyond political differences. And so that particular group is a bipartisan group in in in congress. You it's a congressional cancer caucus. And, again, you know, they don't normally meet people from outside the US. You know what I mean?
Speaker 3:So it was a particularly fantastic opportunity. And the day before, we actually had the, Mark and myself on a panel in an amazing venue in the United States Institute of Peace, and that was to celebrate essentially the 25 years of Intertrade Ireland, which is another cross border body. And we were again able to talk and refer to the the, tripartite initiative. So I suppose what what one thing that I kind of acknowledge from that is we have something to bring to the table here as well in terms of a story and how you can actually you you know, cancer can be this topic that we you know, it's common interest. It's not only across borders, but across religions, across different backgrounds.
Speaker 3:We can actually work together to to solve these things.
Speaker 4:Really important what Lynn said because I think the other thing that we really learned and we've learned over the last number of years is that we we punch above our weight in Ireland and Northern Ireland. And so, for example, we have a doctoral training program with the National Cancer Institute in Washington, and we had a, celebration of that last year. And we also met some of the, students on that this year. But it's been so successful that the US researchers are saying to us, you know, these guys are so good that you're sending over. These are from Queens that, we want more of them.
Speaker 4:So we've been very lucky that we're just hasn't officially yet, but we've just been awarded an all island National Cancer Institute doctoral training program grant so that we'll be able to send researchers from different institutions on the island of Ireland to the NCI as part of their doctoral training program. And so I I think it's important that it's a two way process. It's not just the US helping us to sort of get her, you know, sort of, uh-uh self in shape. It's actually a joint partnership of equals and they also see the benefit of it and that the quality of the people who are coming over is as Liam said, you know, the quality of people who go to the states, do their training, then come back and lead programs on the island of Ireland. And so it's a really win win situation.
Speaker 4:But any partnership of equals, which I think is really important.
Speaker 2:It really is because I know 25 years ago, you know, you were given the bones of the project and, the US involvement was there backing it as part, obviously, of the Belfast, agreement. But as you've said, 25 years on, that's still that connectivity is still very much there, and it is an equal partnership, And you're both bringing benefits to the table. And speaking of which, then ACRE then Yi turned around and Yi have hosted this amazing Euro American forum on cancer, in pharmly in Dublin, you know, really renowned speakers and also involving ASCO, the American Society of Clinical Oncology, a huge array of very important researchers and clinicians. And how did that come about? And, that's obviously another key achievement, for the the collaboration.
Speaker 3:Yeah. I might start, and then Mark comes in. Like, this is, I think, certainly Mark's baby, and I'm I'm helping on the wings. But, again, this is driven primarily by by Kieran Briscoe and Mark. And I suppose the context here is I call it like it's like the Davos of cancer.
Speaker 3:Really, we're we in one room, we want suppose the top kind of researchers, but also people of broader stakeholders from, from America, Europe to really talk about 2 key issues in the area of lung cancer and cancer inequalities over 2 day periods. That was the context behind the meeting. And I suppose the idea is one of the reasons why lung cancer was obviously a no brainer in the sense that, you know, Ireland this year marking the 20th year anniversary since the ban on smoking in public places. And I suppose that was really the key context. And I suppose, you you know, one could argue you could have organized it in Brussels.
Speaker 3:It might have been easier for some people to organize in Brussels, but that was a kind of key argument for us. But, also, what we've been doing at an ACRE level is kind of just breaking down silos, bringing people together. It fits very naturally into that context. And I suppose I'll leave pass it over to Mark in terms of the the broader
Speaker 4:No. It's it was it's absolutely superb and 2 days. We're we're absolutely wrecked now after it still. But, it was just, you know, as as Liam said, it was really we we pitched first. The obvious thing would have been just to have this in Brussels but actually to be fair the organization saw what we had done, saw the you know the sort of partnerships that we had developed.
Speaker 4:Obviously none of us are involved in different European organizations and have very close affiliations with US organizations. It actually made sense of Ireland being the bridge, if you like, between Europe and America. And they actually sort of saw that vision that we had. And, again, it took us probably about a year to put this together in terms of, you know, because we had to pitch for it. It wasn't that they just said, oh, yeah.
Speaker 4:Half in Dublin. No problem. And so we had to sort of justify why Dublin? Why not Brussels, for example? But it was just, I mean, the the passion in the room, the sense of something really special.
Speaker 4:You know, that's that's Liam. I I love Liam's phrase to to tell us of of cancer because it is right. We were bringing together really the top people to discuss big issues and to come out with recommendations in relation to how we can really supercharge the sort of Euro American partnership because you know, we shouldn't just be insular on the European level or a US level as well. This is you know, we should be looking at ways in which we can actually help in low and middle income countries and, see how the US and Europe have a role to play in that. And if you like, we were the broker of that conversation.
Speaker 4:So again, yeah, still still recovering, but it was a wonderful event.
Speaker 2:And just really to emphasize again, the quality of the speakers that you have there. I mean, the influencers, I mean, the American Cancer Society, the European Cancer Organization, the American Society For Clinical Oncology, the US National Cancer Institute, obviously, ministers, north and south, politicians from the US as well, as well as Irish politicians. It really was a unique event and such high level people in cancer research, in cancer policy, in cancer delivery, such an amazing collaboration, and hopefully something that will spur, you know, further collaboration, further projects.
Speaker 4:We're already working on how the recommendations will be implemented. And, obviously, it it's timely as well from a European perspective because, obviously, we're coming up to the European elections. The the one of the manifestos from the European Cancer Organization was very sort of strongly promoted in relation to that. And, obviously, we will have the American elections in November. So it's an important time politically as well, and you need to influence.
Speaker 4:And that's why we felt that this was really important that we could help drive that initiative and and contribute in some small way to the overall changes that we hope will happen both in Europe and in the US, but all around the world in the fight against cancer.
Speaker 3:Yeah. And we're also what was great is we were able to showcase a a bespoke painting. I refer back to Vincent. So Vincent's been working with, and worked with a variety of different contributors who spoke, for example, Julie Grelo, who's the chief medical officer of ASCO, you know, major organization, Kathy Oliver, you know, Key, patient advocate, working with various different individuals telling the story of not only ACRE but also the US Ireland links and Ireland European links, all in just one painting. So that essentially was showcased at the event.
Speaker 3:So this is a truly unique kind of piece, which can tell the story of of what we've been doing.
Speaker 2:And both of you really emphasize the importance of not working in silos, connecting together, collaboration. Cancer knows no boundaries, and that's not just north and south. That's working with, our colleagues in Europe, working with our colleagues in America, and how fruitful that can be and how technology and data can really help us work across those borders. And, that information looks at so many different areas of cancer care and cancer prevention and survivorship. So I think a really exciting and interesting chat today.
Speaker 2:And, for those who'd like to find out more, if you just look up the, ACRI at the website, all that information is there. And, hopefully, we will hear more about your your future projects. So that's aicri.org. And, I think that's all we have time for. So, thank you so much, professor Lawler and professor Gallagher, for joining me to chat about innovation in oncology research today.
Speaker 2:Please tune in for further episodes of the Innovation in Healthcare podcast series.
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