‘Developing an affordable cancer care system for India is critical but it has to recognise, a complex and long-term goal’
Drawing on your own experience as a breast cancer surgeon, what are some of the avenues for Indo-UK collaborations?
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| Prof Arnie Purushotham |
India has a strong reputation for cancer surgery including technical and procedural innovation. The volumes and complexity of surgical cases we see in India and the UK are very different and there are clearly important areas for education and training. For example, the volume and complexity of head and neck, upper and lower gastrointestinal, breast, and prostate cancer procedures carried out in India could provide UK surgeons with significant training opportunities. From the UK perspective, the development of the National Cancer Research Institute and our cancer research networks has led to one of the most research intensive and active cancer care systems in the world. There is significant opportunity for training cancer healthcare professionals from India, be they nurses, doctors, etc. in world-class research methodologies. At King’s Health Partners Cancer Centre (KHPCC), we are now in partnership with Tata Memorial Cancer Centre, Mumbai for their clinicians to complete our one-year Masters degree in Cancer Research. There are also significant opportunities for collaboration in health services research and cancer policy. The UK has a strong reputation in working in social determinants of health and at KHPCC we have major programmes in early detection of cancer and global cancer policy.
How can these collaborations potentially impact patient care in resource-strained countries like India where most healthcare expenditure is out-of-pocket?
Developing an affordable cancer care system for India is critical but it has to recognise, a complex and long-term goal. India’s health transition means that not only will the country need to provide care and control for non-communicable diseases like cancer but also continue to address malnutrition, infectious diseases and maternal mortality, amongst many other health issues. India needs collaborations that have, at their heart, the need to deliver equitable and affordable care to all. Joint research programs that focus on public health needs are particularly important and the UK has a long history of working on methodologies and approaches to these sorts of major research programmes. Our work in cancer policy is based at King’s Health Partners or NICE International (who are affiliated with King’s Health Partners). This is helping to frame new approaches to
financing and priority setting in cancer health systems, as well as provide different models for national cancer research systems. Collaborations are critical for helping catalyse and frame complex and politically sensitive areas such as delivering affordable cancer care and driving out catastrophic out of pocket expenditure.
Can you give us some insights into key areas of your research and how this will impact the detection and treatment of breast cancer in the future?
My areas of research in breast cancer encompass laboratory, translational and clinical research, from bench to bedside and back to bench.
Patients with cancer die as a result of spread of cancer to secondary sites in the body (metastasis). In the lab, we are trying to understand what factors determine the spread of breast cancer cells to specific secondary sites by analysing genes expressed by the primary cancer cells. This will enable us to identify key molecules that may be targeted in the future to
help prevent and treat metastasis.
A significant proportion of women who have their armpit lymph glands removed as part of their treatment for breast cancer will develop swelling of their upper limb (lymphoedema). Our research has demonstrated that some women have a pre-existing underlying susceptibility that predisposes them to developing lymphoedema. Identifying this subgroup of women in the future may help develop strategies to prevent this distressing side effect of treatment.
Approximately 25 per cent of women who undergo ‘lumpectomy’ for breast cancer require a second surgical procedure because cancer cells are discovered to be close to the margin of excision on histopathology. In order to reduce this risk for patients, we are working with industry to develop and apply novel imaging techniques to help guide the surgeon by identifying cancer cells during surgery in order to ensure complete surgical removal of the tumour.
Finally, we are testing a novel targeted treatment (PI3 kinase inhibitor) in women with hormone sensitive breast cancer which is given upfront in their treatment before surgery. Pre-clinical work indicates that this therapy has the potential of being highly effective when combined with aromatase inhibitors, a treatment used in women with hormone sensitive breast cancer.
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