|
PRIORITIES FOR R&D
The 25 priority areas identified by the Advisory Group are shown in Table
1. The Group recognised the difficulties of comparing priority areas from
such a wide and disparate field as cancer research. It therefore felt that
the priorities should be divided into two bands indicating those of very
high priority separately from those of high priority. It should be
emphasised that all of the areas identified are regarded as being
important priorities for research in cancer focused on the NHS. Within the
very high priority and high priority groups the individual cancer research
priorities are listed in an order reflecting the natural history and
clinical history of cancers from early disease through to palliative care.
Detailed descriptions and justifications for each of the 25 areas are
given in Annex
9.
ADDITIONAL RECOMMENDATIONS
The Advisory Group identified several additional areas which must be
regarded as having great importance within the NHS and which differ in
their nature from those represented by the 25 priority areas.
1. |
The first of these is the
provision of a comprehensive infrastructure for clinical trials
through the collaboration of all interested parties, including the
NHS, and the need for a thorough examination, including overviews,
of existing randomised trials for cancer management. The Advisory
Group strongly recommend that the maintenance of a comprehensive
clinical trials infrastructure should be a very high priority for
the NHS. |
2. |
Second, the Advisory Group
recognise the importance of Cancer Registries not only as a valuable
research tool but also for planning and monitoring cancer services.
Their maintenance will be essential. |
3. |
Third, the Advisory Group
recommends that work on the economics of cancer be commissioned soon
and preferably earlier than other work. The knowledge base on the
costs of cancer to the NHS is considered to be inadequate. To know
more here would be helpful when commissioning the priorities and
would inform any future reviews of R&D needs in this field. |
Health promotion was not separately
identified as an R&D subject area. Nonetheless, it can be seen from
the recommended priorities that this very important strategy for health
gain has not been overlooked by the Advisory Group.
Taking into account the level of funding likely to be available for
commissioning research, the Advisory Group recommends that clear lines of
communication should be established between the Commissioning Group and
other cancer research funding agencies who should be encouraged to take
account of the agreed priorities in their forward planning. The Advisory
Group recommends that a comprehensive infrastructure for clinical trials
within the NHS should be maintained through the collaboration of all
interested parties, including the NHS, in future large developments.
TABLE 1
RECOMMENDED R&D PRIORITIES IN CANCER
|
VERY
HIGH PRIORITY
(The letters in brackets indicate the priority justifications in Annex
9.)
|
(A) |
Ways of effecting,
maintaining and evaluating behavioural changes leading to a
reduction in smoking at all ages, particularly children. |
|
|
(B) |
The organisation
and evaluation of services, including medical, psychosocial,
counselling and other services, to meet the needs of those found to
be at high risk of cancer due to a genetic susceptibility. |
|
|
(C) |
Factors
influencing delayed presentation by patients (e.g. psychosocial) and
variations in onward referrals by physicians to oncology
specialists. |
|
|
(D) |
Factors
influencing the accrual of patients into cancer trials (including
why clinicians are reluctant to enter patients into national
multi-centre trials). |
|
|
(E) |
Studies designed
to explain variations in disease outcomes, particularly in relation
to variations in patterns of practice. |
|
|
(F) |
Comparison of care
for common cancers (e.g. lung, breast, colorectal) in specialist and
non-specialist treatment settings with respect to psychosocial and
clinical outcomes; and the relative costs of managing each step of
disease progression. |
|
|
(G) |
The clinical
utility of second-line chemotherapy in advanced common cancers,
particularly its comparison to best supportive care. |
|
|
(H) |
Effective ways of
helping health professionals break bad news, elicit concerns and
respond to patients and relatives for their best psychological
adjustment. |
|
|
(I) |
Optimal management
strategies for unrelieved symptoms, including pain and non-pain, in
cancer patients. |
|
|
(J) |
The most
appropriate and cost effective model of service delivery and level
of provision of palliative care services, including the role of
Nurse Practitioners in hospitals and the community, and for the care
of patients dying in acute hospitals. |
|
HIGH
PRIORITY |
|
|
(K) |
The early natural
history of cancers that may particularly lend themselves to
screening to reduce mortality (e.g. prostate, oral and skin
cancers). |
|
|
(L) |
Comparison of the
value of MRI with current breast cancer screening methods in high
risk women. |
|
|
(M) |
Appropriate ways
of screening for preventing and diagnosing colorectal cancer,
including "once only" flexible sigmoidoscopy and molecular
screening. |
|
|
(N) |
The natural
history of cervical neoplasia and the potential role of Human
Papilloma Virus (HPV) sub-typing in screening. |
|
|
(O) |
Application of new
technologies, including imaging and molecular pathology (e.g.
Polymerase Chain Reaction (PCR), Fluorescence In-Situ
Hybridisation (FISH), cytogenetics) for improving tumour diagnosis
and for the prediction of tumour behaviour and response to therapy. |
|
|
(P) |
Imaging techniques
for the definition of tumour spread, in the detection of metastases
and in the evaluation of response to treatment. |
|
|
(Q) |
The most cost
effective way to provide information to meet the needs of cancer
patients, their families, health care professionals and the public. |
|
|
(R) |
The psychosocial
consequences for patients who have increased participation in
clinical decision making. |
|
|
(S) |
Methods for
managing the introduction of innovative therapies in a cost
effective way. |
|
|
(T) |
Optimal imaging
methods for determining residual tumour mass and for the follow up
of patients given primary treatment for common solid cancers. |
|
|
(U) |
The roles of
adjuvant, neo-adjuvant and combined modality treatments for primary
common cancers. |
|
|
(V) |
Cancer treatment
of the elderly including clinical outcomes and cost effectiveness. |
|
|
(W) |
The value of
integrating quality of life data and data on costs in the
measurements of outcome in prevention, treatment and care of cancer
patients and their carers. |
|
|
(X) |
Comparison of the
cost effectiveness of different psychosocial interventions including
complementary therapies and voluntary groups for patients and their
families. |
|
|
(Y) |
What prevents
terminally ill patients from dying at home, if they so wish, and how
can General Practitioners and their teams access information to help
them care more effectively for their patients at home? |
|
GUIDANCE FOR DEVELOPING
RESEARCH PROPOSALS
When proposals are considered, the Commissioning Group will assess them on
a range of criteria. Relevance to the NHS, scientific quality and the
ability to complete the work adequately in the time set will be of
paramount importance. Within the NHS R&D programme it is an important
principle that funded work is relevant to the NHS. Factors such as the
burden of disease and costs to patients, carers and the NHS will,
therefore, be considered by the Commissioning Group. Research methods and
the experience of researchers should be such that the R&D priorities
can be adequately researched and appropriately directed towards the needs
of the NHS; multi-disciplinary studies will be welcomed where these are
relevant. Researchers should acquaint themselves with the recommendations
for cancer R&D made by other CRDC Advisory Groups, such as the
Standing Group on Health Technology, and any other relevant R&D
priorities within the NHS R&D programme.
NHS CONSUMER GROUPS
Cancer places a major burden not only upon patients themselves but, also,
upon their relatives, friends and carers. Cancer is a common disease and
NHS consumers include people from many different backgrounds.
Consideration of this wide community should not be forgotten - its needs
and interests should be incorporated whenever possible into research
protocols.
Next
Page (Acknowledgements)
CRDC
Report: Contents Page
|