Trialling a personalised bowel cancer treatment plan in response to the coronavirus pandemic

Dr Diana Tait, Consultant Clinical Oncologist at The Royal Marsden Hospital, discusses the potential changes to bowel cancer treatment following the coronavirus pandemic.

How has coronavirus impacted cancer treatment?

Importantly the NHS managed to quickly adapt to deal with the coronavirus, but this success has meant other critical services have been impacted. One of these services is cancer management. Cancer treatments such as surgery have been delayed due to concerns about coronavirus infection in hospital and the availability of critical care facilities.

Before coronavirus, the management of cancer treatment, including surgery, was decided by the multi-disciplinary team (MDT) structure. This meant that all new cancer patients, and any with significant changes to their treatment, would be reviewed by a team of experts. These experts looked at a person’s imaging (scans), the behaviour of their cancer (including the stage and grade), the person’s fitness, and individual wishes for treatment. They would then recommend a treatment plan – which treatment is best and when it should take place. When there is healthcare capacity (having enough time and resources to provide treatment) people diagnosed with cancer are usually treated within a certain timeframe based on UK government targets.

However, because of delays caused by coronavirus, there is currently a ‘queue’ of people waiting to be assessed by the MDT experts, which includes people diagnosed with bowel cancer who may require surgery as part of their treatment. This queue will be lengthened once screening and diagnostic services restart. This means that priorities will have to be made depending on an individual’s cancer diagnosis and an effective new treatment process, including when surgery should take place, may be needed.

What’s a potential solution?

A number of London hospitals are hoping to pilot a new treatment process based on an individual’s ‘cancer biology’. Cancer biology means the way the cancer behaves (if it’s growing and how quickly). It’s been designed around people affected by bowel cancer.

The proposed new system would compare the CT and MRI scans taken over an interval of weeks to months to show how the cancer is behaving and how fast it’s growing. When and if surgery is needed to treat a person’s cancer will be decided by how their cancer behaves. For example, some people may have a fast-growing cancer and need surgery as soon as possible while others who have a slow-growing cancer can safely delay surgery because there is no additional benefit to having surgery straight away. Some people may never need surgery, instead just careful monitoring.

The new treatment system would prioritise the individual based on their specific cancer biology. People would need regular check-ups. This will ensure they receive the most effective care at the right time.

Using this new process of cancer biology the treatment team could provide a more effective treatment plan ensuring the best outcome and care for people diagnosed with bowel cancer.

Why is this process effective?

Understandably, any change to current treatment plans may cause anxiety to people receiving treatment. However, this new system could be more effective as treatment will be tailored to the individual’s needs rather than government targets.

This new process would mean that people are regularly assessed by a team of experts (the MDT structure) to make sure they start treatment when they need it. This could be a long-term solution to improve treatment options for people affected by bowel cancer by avoiding unnecessary surgery for some patients.  

We already have evidence to support delaying surgery. Usually people being treated for bowel cancer have surgery four to six weeks after chemoradiation (chemotherapy and radiotherapy at the same time), but evidence shows that waiting three months allows the cancer to further shrink without any negative effects.

Supporting this new approach to bowel cancer treatment is global data showing that some people can have their cancer safely monitored, rather than proceeding straight to surgery. By following this approach, it’s hoped that people can avoid having surgery that could cause long-term side effects if their treatment team do not think it’s necessary. 

What does this mean for people affected by bowel cancer?

For now, The Royal Marsden is hoping to use this new treatment process in their Cancer Hub as a pilot for a new treatment approach. It’s hoped that other hospitals may adapt their treatments in line with this method, especially as coronavirus means hospitals are having to explore new ways of providing treatment.

By following this new treatment process, we aim to protect people from unnecessary surgery, provide access toappropriate surgery and reduce their risk of coronavirus infection, whilst still delivering high-quality care.

Although it’s being piloted to help ease the increased demand in cancer services that’s expected after the coronavirus peak, if the new treatment process is effective, it could be a long-term treatment strategy. It could also be expanded beyond surgery for other bowel cancer treatments such as chemotherapy or radiotherapy. It has the potential to personalise treatment plans to the individual. 

We’re here for you

We’ll continue to monitor this fast-moving situation, listen to your concerns and raise awareness. As always, our determination to support everyone affected by bowel cancer remains our top priority.

• Visit the coronavirus section of our website
• Get the latest news and updates by following us on Twitter, Facebook and Instagram
• Contact our nurses if you have any questions or concerns about bowel cancer