The COVID-19 pandemic has changed how science is done. Cancer researchers in leadership positions have taken swift action to protect patients, support students and postdocs, and continue to do research in a climate of uncertainty. Here, 8 mid-career and senior cancer researchers we fund tell us about the choices they’ve made and their outlook on the future.
Ingo Ringshausen, dealing with uncertainty in the clinic and in the lab
I’m a haemato-oncologist and I also do lab research on leukaemia and lymphoma. When it became unsafe for patients to have face-to-face hospital appointments, we started to run our clinics by phone. We’re able to care for many patients in this way, but there are things we can’t do remotely. When someone is newly referred to us, we need to physically check their symptoms to decide what the next diagnostic or therapeutic step is. It’s also difficult to manage the care of patients who had their treatment stopped or not started because of the risk of COVID-19 infection if they came into a hospital.
We’re seeing fewer patients with cancer now than before the pandemic, which probably results from a drop in the number of diagnostic procedures. Once we go back to a more normal situation, there will be a rebound in the number of patients who will need to be seen, diagnosed and treated. The NHS has been running on low resources for several years, so it will be challenging to deal with this influx.
Patients with cancer – and society more broadly – have been very grateful for the work we’re doing as part of the NHS at this difficult time. However, people seem to be less aware of the impact of the pandemic on cancer research – including its financial impact on a big charity like Cancer Research UK (CRUK) and their ability to fund research.
I’m in the last year of my CRUK fellowship and I worry about not being able to secure funding afterwards. My team has had great results: we found new drugs that can improve chemotherapies, we’re about to publish another important paper on our work and we’re spinning out a company to develop these agents. However, we’re a small team of 4 postdocs, a PhD student and myself, and a lack of continuous funding would jeopardise the existence of the lab.
As we return to a more normal way of life, I am concerned about ensuring there is ongoing support for mid-career cancer researchers who are not fully established yet. Without it, we could lose an entire cohort of scientists and the fruits of their research.
Ingo is a consultant haematologist at Addenbrooke’s Hospital in Cambridge and a group leader at the Wellcome – Medical Research Council Cambridge Stem Cell Institute. He is supported by a CRUK Senior Clinical Research Fellowship.
Sophie Acton, keeping the team motivated
We are a wet lab and we do a lot of cell culture and microscopy. We look at lymph nodes to see how immune cells interact with fibroblastic stromal cells in a normal immune setting, which helps us understand how these types of cells interact in a tumour microenvironment. Since the lockdown, we’ve been doing data analysis, writing, publishing, collaborating and planning – but our lab research has stopped.
There are about 10 of us, and our situations are diverse. I’ve been trying to strike a balance between keeping people motivated to do what they can from home, and not putting too much pressure on those who need to combine childcare and work. I reminded our PhD students that they have done a lot of work already and they can start writing chapters for their theses. Our postdocs are worried, but I assured them I’ll be able to extend their contracts when we get back.
We’re staying connected to all other members of the team. I have individual meetings with everyone and a lab meeting once a week. We set up an online spreadsheet where we collect our steps for the day, to encourage each other to get outside or do some exercise at home. Our students have calculated that together we’ve already walked to the North Pole.
We discovered that there’s much more we can do from home than we expected. Some people, particularly the more junior members of the team, have really found a benefit in slowing down. When we go back to the lab, I’m taking forward the lesson that we should take more time to reflect, analyse and think about what the right next step is, rather than getting sucked into racing too fast.
I hope that in the long term everyone will understand that we need to invest more in science because it’s science that will rescue us from health emergencies like this pandemic. Science expands the pool of human knowledge, which will be ready for when we need it.
Sophie is a group leader at the Medical Research Council Laboratory for Molecular Cell Biology at University College London. She is supported by a CRUK Career Development Fellowship.
Dean Fennell, making the most of technology
I’m based at the Experimental Cancer Medicine Centre in Leicester and my team researches new biomarkers and therapies for mesothelioma. We have a portfolio of phase 1 to phase 3 clinical trials and we’re also involved in translational activities. We had a protracted lockdown in Leicester compared with most of the UK, but we’re in the process of restoring normality.
We’ve had to suspend recruitment of new patients into clinical trials because of the pandemic, but the patients already enrolled were able to continue their treatment. For example, the patients in our Mesothelioma Stratified Therapy (MiST) phase 2 trial – which I believe is the first attempt to use molecular testing to prospectively stratify patients with mesothelioma so they can receive personalised therapies – have been having virtual clinical appointments and receiving their oral drugs at home.
Technology has been a lifesaver, both in the clinical setting and in a research context. Virtual meetings and desktop collaboration software have enabled us to share data and interact within our team and with our collaborators in the UK and abroad. Many scientific conferences have also become virtual. For example, I’m an invited discussant at the Virtual Presidential Symposium of the International Association for the Study of Lung Cancer, which will be broadcast worldwide on 8 August. These changes in the way we use technology may remain well into the future.
We’ve had to put our laboratory research on hold. However, we had large amounts of data to analyse, so we took the opportunity to reflect on, consolidate and publish what we had. Our computational analysis of genomic data has really matured over this period, and we’ve just submitted a manuscript based on this work.
There are still a lot of unknowns about the future of our economy, including funding of the academic sector. We’ll be flexible and explore multiple types of funding sources. Our understanding of patient heterogeneity with regards to response to cancer treatment has increased exponentially in the past few years, so we see a great opportunity to attract funding from industry or from partnerships between industry and organisations such as CRUK.
Dean is chair of Thoracic Medical Oncology at Leicester University and group leader at the Leicester Experimental Cancer Medicine Centre, of which CRUK is a major funder. He also leads the CONFIRM phase 3 clinical trial for mesothelioma, which is supported by Stand Up To Cancer.
Grant Stewart, learning from COVID-19 to improve cancer care
I’m an academic surgeon focussing on urological cancers. But the COVID-19 pandemic has completely changed the way we treat patients who would normally have surgery. This is because our operating capacity has dropped, but also because COVID-19 infection increases the risk of death in people who have surgery.
We need a lot of data to calculate this risk accurately so we can make the right decisions. This is why I became involved in COVIDSurg, an international study set up as part of the GlobalSurg initiative – a global network supporting collaborative research into surgical outcomes. COVIDSurg includes a data repository that tracks the outcomes of patients with COVID-19 who have surgery. In May, the COVIDSurg collaborative reported the results of the first cohort of patients enrolled in the study. Given the high risk of lung complications and mortality seen in these patients, the authors recommend that surgery is delayed or avoided in people with COVID-19 whenever possible.
COVIDSurg has also shown that millions of operations have been cancelled globally, and we need to understand what this means for people with cancer. I’m leading the urology arm of the COVIDSurg-Cancer study and I’m trying to make sure we collect the right data for kidney, prostate and bladder cancer.
We’re looking at short-term patient outcomes, but we’re also very interested to see what happens in the long term. Some patients are going to be waiting much longer than normal for their operations. Some are going to have treatments that doctors wouldn’t normally give them, for example pre-surgical chemotherapy, or radiotherapy instead of surgery. Others might miss out on treatments.
Some of these people will sadly come to harm, but some might benefit from the changes in treatment or diagnosis that the COVID-19 pandemic brought in. So, the information we’re gathering over this period might change clinical practice. We never thought we’d gain this knowledge because it’s unethical to delay treatment or not give treatment. But this situation has been forced on us and we should try to learn from it.
As we’re entering a more chronic phase of COVID-19 infection, we need to understand what this means for cancer surgeons, clinical trialists and researchers. Personally, gaining knowledge and expertise about COVID-19 has been useful to project what might happen to the normal working lives of medical professionals and researchers and to educate other people I work with.
Grant is a professor of Surgical Oncology at the University of Cambridge, an honorary consultant urological surgeon at Addenbrooke’s Hospital and a co-lead of the CRUK Cambridge Centre Urological Malignancies Programme.
Sheeba Irshad, unpicking immune responses in COVID-19 and cancer
I work as an oncologist caring for patients with breast cancer and I also lead a group researching hard-to-treat breast cancers, such as those that are resistant to chemotherapy. The COVID-19 pandemic has been a really challenging time for everyone in the world, but particularly for our patients with cancer.
At the end of February there were small-scale studies from China suggesting that people who had chemotherapy or surgery within the 4 weeks before they developed COVID-19 had an increased risk of having severe symptoms and poor outcomes from the infection. But no one really knew precisely how bad the situation would be for patients with cancer who got COVID-19. And, as oncologists, we also know that we can’t put all patients with cancer into the same box.
We needed to dig deeper. We knew that patients with COVID-19 who go into intensive care have an overactive immune system, which damages their lung tissue. Some approaches to treat cancer dampen the immune response – could they help patients with COVID-19? And how do people already in an immune-compromised state respond to the virus?
I had COVID-19 myself. As I was going into isolation with my family, I started writing the protocol for what is now the SOAP study. This trial compares immune responses from people with cancer with or without COVID-19, from people without cancer who have COVID-19, and from healthy volunteers.
Clinical trials usually take months to set up, but we managed to have this one up and running in about 3 weeks, which was amazing. This experience clearly demonstrates that we can set up clinical trials very quickly if we have the workforce. This project also involved people from many different specialties, and this is something that needs to continue to happen in cancer research. Cancer is a complex entity and we need to pull in expertise from different areas to succeed.
Sheeba is an honorary medical oncologist at Guy’s & St Thomas’ NHS Trust in London and a group leader and senior clinical lecturer at King’s College London. She is supported by a CRUK Clinician Scientist Fellowship.
Anna Philpott, steering university research and teaching
I’m a developmental biologist working on paediatric cancer. I’m interested in how normal processes that happen during the development of embryos get disrupted in children’s cancers.
We were finishing the experiments for a crucial manuscript when lockdown began. I now have to re-write the manuscript and I’m finding this hard to do remotely, as I can’t brainstorm with people in the same way as before. As we had to stop lab work quite abruptly, we’ve also lost some of the cells we were growing into stable cell lines. We’ve frozen several batches with fewer cells than we’d normally have, and we’re just hoping that when we thaw them the cells will start growing again.
In addition to leading a research team, I’m the head of the School of the Biological Sciences at the University of Cambridge. We’ve had to learn to be very nimble in making decisions. First, we had to quickly decide how we were going to teach and examine the students in this final term. Then, we had to shut down all research buildings. Finally, we had to make sure that all of these buildings can re-open in a safe way.
I worry about the long-term effects of the COVID-19 pandemic on healthcare, because people haven’t been going to the hospital. It’s also hard to know how much money there will be for research at the end of this, including from CRUK. We’ve benefited a lot from having the CRUK Cambridge Centre. I used to run the Centre’s studentship programme until a year ago, and we get fantastic students. Will we get the same number of students in the future? Will we get overseas students? What will their job prospects be?
The best advice I have for young scientists is that their career is long, and they shouldn’t think that a bad thing that happens now will define everything in their future. You might end up doing something that you wouldn’t have done, but that thing might turn out to be better. So be kind to yourself.
Anna is a professor and the head of the School of the Biological Sciences of the University of Cambridge and group leader at the Wellcome – Medical Research Council Cambridge Stem Cell Institute. She is supported by a CRUK Programme Grant and is a member of the CRUK Children & Young People’s Steering Group.
Sarah Bohndiek, navigating a multidisciplinary boat
I’m applying my background in physics to cancer research. My team develop new imaging technologies to improve early diagnosis of cancer, understand better how tumours respond to therapy and monitor that response in a more precise way. Our research ranges from developing hardware, to doing computational data analysis, to applying our technologies to patients in clinical trials.
We’re split across different labs, so the lockdown didn’t change our ways of working very much. But it did have an impact on people’s time – especially on those with caring responsibilities – and mental wellbeing.
Several people are worried about their future in research. For example, postdocs whose contracts are running out and who are applying for new funding don’t know what will happen to their applications. In the years to come, I hope that people and organisations, including funding bodies, remember the generation that was impacted by this pandemic will have different CVs than the generations who came before and after.
We’re also concerned about the effects of the pandemic on the funding of cancer research in general. A discontinuity in research funding will have a huge impact on patients with cancer in the future.
Despite all of this, the team has been very creative and has come up with lots of ideas they could develop from home. Being a multidisciplinary team will help us get back to normality, as we’ll be able to prioritise access to the lab for people who need to run experiments, while keeping those who do computational work working from home for longer.
This period has also given us an opportunity to think outside the box. All too often, the computational analysis of imaging data is an afterthought to the experimental data acquisition. Now, as people spend more time designing their experiments, we will produce better, curated open-access datasets that the research community can use.
Sarah is a reader in biomedical physics at the University of Cambridge and a group leader at the CRUK Cambridge Institute and co-lead of the CRUK Cambridge Centre Early Detection Programme. She has recently been appointed professor at the University of Cambridge and will take this position in October.
Sergio Quezada, forging ahead with cancer research
My team is interested in understanding the relationships between a tumour and the immune system, and in using that information to design new therapies. We’re working with Roche on an antibody, developed by my team, that can kill a subset of cells that protect tumours.
Roche has begun to give the antibody to patients in a clinical trial, but the COVID-19 pandemic affected patient recruitment. We hope the trial will go back to normal soon. When we entered lockdown we had just completed the final experiments for a big paper on this project, so we focused on finishing that paper from home.
Several labs repurposed themselves to help with the COVID-19 emergency, and I think that was a necessary thing to do. Our team continued to work on cancer research, but we donated all of our protective personal equipment, such as gowns and gloves, and offered our PCR machines to the COVID-19 effort. And our incredible clinical fellows postponed their PhDs to move to the clinical frontline.
Fortunately, we didn’t lose any critical animal models, and one person was still allowed to go to the lab to take care of our cell lines. But our experimental work has stopped, and re-starting will take time. For example, as clinical trials have been halted, there will be delays in collecting the clinical samples we need even after we’re back.
What drove me into cancer immunology was the great unmet need that exists in this area, and I remain determined to advance cancer research. I’m developing a very big project on brain tumours – the largest ever of its kind – and we’ll continue our work on lung cancer and biotherapeutics.
The continued investment in cancer research over the past several years has created a fantastic, internationally recognised research environment in the UK. Stopping funding now would not just stop one research project, it would stop this well-oiled machine. We can’t let this happen, cancer needs to be tackled.
Sergio is a professor in cancer immunology and immunotherapy and a group leader at University College London Cancer Institute. He is supported by a CRUK Senior Career Development Fellowship.