Human involvement in AI-driven digital pathology pathways ethical and legal considerations

PHG – 2023

One of the most promising areas for the development of AI is digital pathology, where computers are trained to recognise areas of potential concern and flag these for further investigation. In early October 2021, the PHG Foundation held a series of workshops that explored some of the ethical and legal factors that may impact the implementation
of AI in digital pathology, drawing on the example of AI for detection of a condition called Barrett’s oesophagus (BE) as part of Project DELTA. This report forms part of Project DELTA, funded by Innovate UK and Cancer Research UK which seeks to improve the diagnosis of oesophageal cancer. It is an output from Work Package 3 of the project which aims to develop and validate a deep learning framework to assess Cytosponge™ samples. By combining digital pathology, with a novel sampling device consisting of a swallowable and expanding sponge on a string (Cytosponge™) the Project aims to
develop a scalable minimally invasive alternative to endoscopy.

Human involvement in AI-driven digital pathology pathways ethical and legal considerations

Adopting a risk tool for stratification and predictive prevention of oesophageal cancer

PHG Foundation – 2023

On 27 September 2022, the PHG Foundation held a workshop that explored the ethical and legal implications of using a risk tool for risk stratification of oesophageal cancer. This report forms part of Project DELTA, funded by Innovate UK and Cancer Research UK which aims to improve the diagnosis of oesophageal cancer. It is an output from
Work Packages 1 and 2 of the project which aim to develop and validate an algorithm aimed at risk-stratifying patients for whom early investigation will be beneficial, and implement this in clinical pathways for Cytosponge™. It is hoped that the use of this algorithm in the form of a risk prediction tool could help to improve early recognition of
oesophageal cancers and to reduce overuse of prescription acid-regulating therapies

Read the report –Adopting a risk tool for stratification and predictive prevention of oesophageal cancer 

Leveraging the Cancer Care Delivery Plan: Technology and data to integrate cancer research into clinical care

Public Policy Projects (PPP) – 2023

On 19 June 2023, Public Policy Projects (PPP) held a roundtable in partnership with Flatiron Health UK to explore how data can be harnessed to generate meaningful insights to improve patient care, and to enrich cancer research. The roundtable was chaired by Dr Claire Bloomfield, Director of the Centre for Improving Data Collaboration at NHS England, and head of their Data 4 R&D programme, and was attended by senior sector stakeholders including:

• Clinical oncologists
• Cancer epidemiologists
• Health policy experts
• Digital and data leads
• Representatives from cancer charities
• Patient representatives

The roundtable focused on the challenges to be addressed, and the potential solutions, in the use of real-world data (RWD) and real-world evidence (RWE) to advance cancer research and clinical care. RWD and RWE describe the data or information relating to patient health and/ or the delivery of health care routinely collected from a variety of sources. The insights of this report were developed from the content of the roundtable discussion.

Read the Report – Leveraging the Cancer Care Delivery Plan: Technology and data to integrate cancer research into clinical care

International Pooled Analysis of Leisure-Time Physical Activity and Premenopausal Breast Cancer in Women From 19 Cohorts

 Journal of Clinical Oncology – Dec 2023

There is strong evidence that leisure-time physical activity is protective against postmenopausal breast cancer risk but the association with premenopausal breast cancer is less clear. The purpose of this study was to examine the association of physical activity with the risk of developing premenopausal breast cancer.

Further information – International Pooled Analysis of Leisure-Time Physical Activity and Premenopausal Breast Cancer in Women From 19 Cohorts

The Cost of Breast Cancer: Modelling the economic impact to the UK

Demos – 22nd January 2024

This research finds that breast cancer will likely cost the UK economy between £2.6-2.8 billion in 2024, and more alarmingly it reveals the true human cost – we estimate wellbeing costs associated with the disease will amount to a staggering £17.5 billion in 2024.

This report, supported by Breast Cancer Now, sets out how a number of critical interventions can mitigate the crippling human and financial impacts of breast cancer. Our economic modelling shows that higher levels of screening, more cancer nurse specialists and better help for people returning to work would deliver the highest impact.

Read the Report – The Cost of Breast Cancer: Modelling the economic impact to the UK

The future of cancer care in the UK – time for a radical and sustainable National Cancer Plan

Lancet Oncology January 2024

The loss of a dedicated National Cancer Control Plan in England and Wales has been a “major misstep” at a time when the NHS is facing massive workforce shortages and cancer services have struggled to recover after the pandemic; cautioned leading cancer experts in a Policy Review published last November in The Lancet Oncology.

Senior clinical cancer specialists who authored the report called for the development of radical, yet sustainable cancer control plans as they anticipated a need for a cancer service “fit for the future,” with up to 2,000 extra cancer cases a week expected by 2040.

The authors drew attention to the UK’s poor performance compared to other countries, stating that our approach to cancer care contradicts “international consensus”.

Leading oncologist authors cautioned that the lack of a cancer plan is “an incomprehensible decision not in the best interests of people with cancer.” Therefore, the group of cancer experts has published their own 10-point plan as a blueprint for a new cancer strategy.

Further information – 10-point plan overview

Insights for precision oncology from the integration of genomic and clinical data of 13,880 tumors from the 100,000 Genomes Cancer Programme

Nature Medicine (2024)

The Cancer Programme of the 100,000 Genomes Project was an initiative to provide whole-genome sequencing (WGS) for patients with cancer, evaluating opportunities for precision cancer care within the UK National Healthcare System (NHS). Genomics England, alongside NHS England, analyzed WGS data from 13,880 solid tumors spanning 33 cancer types, integrating genomic data with real-world treatment and outcome data, within a secure Research Environment. Incidence of somatic mutations in genes recommended for standard-of-care testing varied across cancer types. For instance, in glioblastoma multiforme, small variants were present in 94% of cases and copy number aberrations in at least one gene in 58% of cases, while sarcoma demonstrated the highest occurrence of actionable structural variants (13%). Homologous recombination deficiency was identified in 40% of high-grade serous ovarian cancer cases with 30% linked to pathogenic germline variants, highlighting the value of combined somatic and germline analysis. The linkage of WGS and longitudinal life course clinical data allowed the assessment of treatment outcomes for patients stratified according to pangenomic markers. Our findings demonstrate the utility of linking genomic and real-world clinical data to enable survival analysis to identify cancer genes that affect prognosis and advance our understanding of how cancer genomics impacts patient outcomes.

Sosinsky, A., Ambrose, J., Cross, W. et al. Insights for precision oncology from the integration of genomic and clinical data of 13,880 tumors from the 100,000 Genomes Cancer Programme. Nat Med (2024).

National Oesophago-Gastric Cancer Audit (NOGCA) report

11th January 2024 – HQIP

The National Cancer Audit Collaborating Centre (NATCAN) has published a State of the Nation report from the National Oesophago-Gastric Cancer Audit (NOGCA) on the care received by people with oesophago-gastric cancer in England and Wales from 1 April 2020 to 31 March 2022.

OG cancer predominantly affects older people and occurs more frequently in men than in women, though there is variation by tumour type. Stomach cancer as a proportion of all OG cancers continues to decline, accounting for 25.1% of all cases diagnosed in 2021/22 compared to 33.8% in 2012/13. Over two-fifths of people in the audit were diagnosed with stage 4 (metastatic) disease, an increase from 37% in 2012/13.

This report also contains key findings in relation to:

• Routes to diagnosis
• Staging investigations
• Treatment planning
• Waiting times along the care pathway
• Curative surgery
• Non-curative treatment
• Nutritional support
• High-grade dysplasia.

Read the Report – National Oesophago-Gastric Cancer Audit (NOGCA) report

Read the Report – National Prostate Cancer Audit (NPCA) report

HQIP – 11th January 2024

The National Cancer Audit Collaborating Centre (NATCAN) has published a State of the Nation report from the National Prostate Cancer Audit (NPCA) on the care received by people with prostate cancer in England and Wales from 1 January 2019 to 31 January 2023. Key messages include:

• The proportion of men diagnosed with high-risk/locally advanced prostate cancer undergoing radical prostate cancer treatment remained stable when comparing to 2019
• The proportion of men diagnosed with low-risk localised prostate cancer undergoing radical prostate cancer treatment was 8% in England and 9% in Wales
• There was an increase in men newly diagnosed with prostate cancer in 2022 in England, and in 2021 in Wales
• There was an increase in men newly diagnosed with prostate cancer treated with either radical prostatectomy or radiotherapy in 2022 in England
• The proportion of patients experiencing a genitourinary or gastrointestinal complication within two years of radical treatment remained stable in England and Wales, when comparing to 2015-2019
• There were changes in some aspects of prostate cancer treatment, including an increased utilisation of ultra-hypofractionated radiotherapy and a shift in the systemic agents used.

Read the Report – National Prostate Cancer Audit (NPCA) report

Cancer multidisciplinary team meetings – standards for clinical radiologists

The Royal College of Radiologists – Winter 2023

Modern medicine requires a multiprofessional team of doctors and allied staff to manage patients effectively in a range of medical conditions, particularly cancer. Imaging plays a key part of the decision-making with radiologists are considered ‘core’ members of multidisciplinary team meetings (MDTMs).

The standards in this document outline the requirements for consultant radiologists to maximise the benefit to patients. They provide recommendations for the resource requirements and attendance at MDTMs as well as audit and how they can feed into REALMs. 

Although most of the guidance applies to cancer MDTMs, many of these recommendations will also be applicable to non-cancer MDTMs and other clinicoradiological meetings.

Read the Guidance – MDTM Standards 2023

MDT Top Tips Infographic