The hospital that will change the story of cancer forever

Catching cancer early

One of the main focus areas for the new hospital is an area in which Cambridge has built unique expertise: early detection and intervention.

"We know that for a lot of cancers there is a latency period where they're either in a precancerous stage or in an early cancer stage before it can ever be diagnosed by conventional methods," says Ford. Are there ways to detect the cancer at this early stage and intervene?

Gilbertson says such an approach will present a ‘win-win’ for both patients and the NHS. "If you detect the cancer early, the survival chances are much better and the treatment needed is generally easier and more straightforward. This is better for patients and much less expensive for the NHS."

The top floor of the future hospital will house the Early Cancer Institute Research Clinic, headed by Professor Rebecca Fitzgerald, a clinical researcher who spends part of her time looking after patients with oesophageal cancer, a cancer that is difficult to treat if not caught early.

"We're being much more proactive," says Fitzgerald. "We're trying to predict who needs more careful monitoring or preventative action ahead of them even knowing they've got a problem."

This will make Cambridge Cancer Research Hospital the only hospital in the UK that has space specifically aimed at preventing cancer, she says. "It's really a testament to putting faith in the fact that we think there are different ways of doing things for the future."

Fitzgerald already heads the Early Cancer Institute across the Campus, which is undergoing redevelopment as the Li Ka Shing Early Cancer Institute to enable world-class fundamental research aimed at understanding how cancers emerge and develop, finding biomarkers to detect it, and developing new strategies to find people at risk and to intervene.

She says the new Research Clinic in the hospital will enable them to translate their discoveries into clinical practice. On the top floor it will have space for healthy and pre-symptomatic individuals to take part in studies as well as a "hotel type of arrangement" where researchers from across Cambridge and beyond – often from disciplines outside medicine, such as physics, engineering and maths – are able to spend a period of time working in partnership with patients to develop and test their innovations.

"The best way to really get research done in the most efficient way is to have it right alongside the patient," she says. "The closer you can bring these things together, to really embed it in the whole ecosystem, it makes it easier for the researchers, it makes it easier for the patients."

Developing a diagnostic test can be a long and laborious process. Fitzgerald knows this only too well. Her capsule sponge for diagnosing Barrett’s oesophagus, a condition that greatly increases the risk of oesophageal cancer, is in the final stages of testing before being rolled out across the NHS, but it has taken two decades to reach this stage.

The hospital has carried out economic modelling that shows how having researchers in geographically dispersed locations – even just across the city, as is the case with Cambridge – can significantly hamper innovation.

"Even for some of the more straightforward inventions that we've invented here, particularly in early detection, could have been developed years faster had scientists been located next to patients," says Gilbertson, who is also Chair of the NHS Innovation External Advisory Board, and so is familiar with the challenges of bringing innovations into the NHS.

"To change the story of cancer, there needs to be a seamless integration between research and NHS care," he explains. "We're seeking to take the very best of Cambridge science and make sure it’s ‘NHS ready’, ensuring it can be readily deployed in York, Hartlepool, Stockport, wherever, patients need it."

Kinder, faster treatments

While the ambition is to catch cancer early enough to cure it – and ultimately, to intervene early enough to prevent it – there will always be patients needing more intensive or longer-term treatment.

In the past, cancer treatments brought with them extremely unpleasant side-effects, but thanks to new generations of medicines and therapies – including so-called PARP inhibitors developed here in Cambridge – treatments can be much more targeted, making them more effective and with fewer side-effects.

Professor Jean Abraham directs the Precision Breast Cancer Institute, which will move into Cambridge Cancer Research Hospital. Abraham and her team use the latest advances in genomics to better match treatment to particular changes in DNA that give rise to the tumour. Once a patient is undergoing treatment, they hope to monitor almost in real time how the tumour is responding – is it shrinking in response to the drugs, for example – and adjust as necessary.

"One of the great things that will happen when we get into the hospital is that we'll have the Precision Breast Cancer Institute and side-by-side to that will be our NHS Breast Cancer Unit for our patients," she says.

Equally exciting, she says, is that next to these will be the Integrated Cancer Medicine Institute. There, researchers will look for ways to bring together the many different data sets collected from cancer patients – from DNA to blood tests and biopsies to medical imaging, for example – and apply artificial intelligence (AI) to guide treatment options.

Gilbertson says this will help them completely transform the currently "very clunky" patient pathway that starts with the patient noticing something is wrong and getting referred by their GP to their local hospital where doctors will run a number of tests.

"Those tests are like a hand of cards," he says. "Doctors currently hold in their hands a bunch of x-rays, blood tests, DNA sequencing, histology, and clinical information and try to compare these to make decisions.

"Comparing these very different pieces of information is hard, and currently involves a group of very smart and very busy people sitting in a room – nurses, doctors, surgeons, radiologists, pathologists – spending many hours trying to make sense of these data for 50 or so patients at a time. You can imagine that this takes hours and is very inefficient."

Multiply this process across the NHS and it creates "massive workforce issues and inefficiencies. But if we could harness the power of AI to read scans, read histology reports, look at genomic data, and importantly integrate all this data, then this could transform the speed, accuracy and efficiency to make real time clinical decisions for 40 of those 50 patients.

"This doesn’t take the doctor out of the picture. Most likely it will provide rapid answers for the 30-40 patients who have more straightforward treatment options, freeing the team to discuss the mode complex and difficult cases."

Listening to the voices of patients

Crucial to the development of Cambridge Cancer Research Hospital has been the involvement of patients – after all, its entire ethos is about improving their lives.

Ensuring that their voices are heard is the responsibility of Elaine Chapman, the Lead Advisory Nurse on the project and herself a person living with breast cancer.

"I see very much part of my role as helping us work out how we're going to make this building work in practice on a day-to-day basis. So for patients, that's about thinking what experience, what things they might be feeling and thinking when they're coming to the building and how can we have an environment that will help them to feel comfortable?"

Chapman is the liaison with the Patient Advisory Group, co-chaired by Fiona Carey and Neil Stutchbury.

"We’re trying to change the experience for cancer patients and make it better," says Carey, who took early retirement in 2012 following her third major surgery, which was for kidney metastases in the pancreas, which took a huge toll on her. "You wouldn’t build a Cineplex without talking to people who are going to use it. If you have your patients around the table from the beginning, you’re going to avoid costly mistakes."

Patients have been heavily involved in the design and building of the new hospital from the start, sitting on all the working groups, alongside the professionals.

"We see things clinicians don’t see," says Carey. "We know things they don’t know. And patients aren’t just patients. They have skills and expertise. They might be engineers, architects, accountants, artists – we all bring stuff into the room beyond what would have been there without us."

Patients groups have been involved in the hospital project since very early on. This has resulted in important changes to the proposed design, such as having changing rooms and procedure rooms connected by a door rather than across a public corridor.

"We all know about gowns," says Carey. "The whole thing is really awkward. Should I wear shoes and socks? Is my bum hanging out the back? Now the design has been changed to remove that problem."

Chapman says there is great enthusiasm for the project among the patients she speaks to. "This new way of doing things, having those University institutes integrated into the building so that research can go from a thought straight to a patient is incredibly inspiring."

Great expectations

Work will begin imminently on the new specialist hospital within the burgeoning Cambridge Biomedical Campus, which is itself located at the heart of the UK’s and Europe’s leading life sciences cluster.

It’s anticipated that Cambridge Cancer Research Hospital will open its doors to patients, doctors and researchers in 2029. For everyone involved, it cannot come soon enough.

"We already do amazing things in Cambridge,” says Chapman. "But by having a new building that has been designed in partnership with patients, clinicians and the University, we'll improve the experience for those working in there and for our patients coming to it."

Ford believes that the atmosphere that they will create in the new hospital will make it feel like "a place that people want to come and work at, and feel that what they do is changing people's lives".

As a practising clinician, he says that for the first time in his career, he looks forward to being able to offer people treatment in an environment that genuinely contributes to their health and well-being.

There's a lot of evidence about the impact of the environment on the patients, he says. "It makes a difference to how they feel about their treatments and it makes a big difference to the way that the staff approach their work. Ultimately, the environment makes a major contribution to successful patient outcomes."

The ambition is for the hospital’s impact to resonate far beyond its four walls, says Abraham.

"We can change the outcomes and the way we care for our breast cancer and other cancer patients, both here and around the world," she says. “What we want to develop are tools and ways in which we can help not just local patients, but regional, national and international patients. We know we can deliver this because of networks of centres who have worked with us nationally and internationally on a variety of studies who we will partner with to increase our global impact."

All of this is possible, says Gilbertson, because Cambridge is "a magnet for brilliance" that spans across the disciplines and from which the Hospital can draw expertise.

"By uniting the brilliance of Cambridge with our patients, we can totally transform the way we practice medicine," he says. "Cambridge is a special place. In fact, it's a special place for the country and beyond. Our vision is not just for the NHS – it reaches to other countries. It's a unique time to achieve that."