What will you be doing ten years from now? I’m not sure I know, unless I win the lottery – but then I’d have to start buying tickets wouldn’t I? If we think about what the next ten years might have in store for us here in the health board we might start with what we already know to help us understand what the future might look like. Let’s begin with the size of the population we will be looking after ten years from now.
Cardiff, the capital city of Wales, is booming and it has become one of the fastest growing parts of the UK with unemployment falling and output growing. In the education sector Cardiff University is strengthening its position as the only Russell Group University in Wales and the other higher education sectors are flying high too.
As you can see the population in our part of the world is going to grow at least twice as fast as the rest of Wales and much more than that in many cases. This is before we factor in the growth the city council have pencilled into the housing stock in Cardiff, with 47,000 new homes to be built according to the Local Development Plan.
What will this mean for health care services? The obvious conclusion is that there is going to be significantly more demand for healthcare, and here we will be experiencing a trend line that moves twice as fast as anywhere else. We need to ensure that the external economic growth taking place in the capital is matched by a commensurate adjustment in the way that resources in the NHS are shaped overall. This is a complex area and there are many nuances and difficulties to overcome, but we are making the case that equity of access to healthcare must have some linkage to equity of resources to provide that access. I will keep you posted on this situation.
It looks like in future we are going to have to become really expert at helping our population stay well and we will also need to ensure that we get even better at selecting the right treatments for the specific problems patients have. To help us with this latter challenge, there is a new era approaching when we will be able to match an individual’s genetic signature to a treatment that is tailored to their individual characteristics, including the responsiveness to the proposed treatment.
Although all LHB’s are now designated University Health Boards, I like to think that there remains something distinctive about our organisation. As I have mentioned before, we contribute more than half of the entire Wales research output, and we have many internationally renowned staff who are leaders in their field. Our close working relationship with Cardiff University is one of our great strengths and provides us with one of the most important ways in which we will be able to meet the challenges ahead.
As an illustration, we know that today, lung cancer is a devastating disease and the UK’s biggest cancer killer. It accounts for more than one in five cancer deaths and is the second most common cancer in men and women in the UK. Working with Cancer Research UK, Rachel Butler and the Medical Genetics Team want to change these odds for people with lung cancer.
Genetic testing is already used to detect DNA changes in lung cancer that point to whether a patient will (or will not) benefit from a particular drug, this is known as Personalised or Stratified medicine. Stratified medicine identifies key molecular changes common to different people’s cancers. Patients can then be grouped based on these shared genetic faults, allowing some people to receive a targeted treatment matched to their group. The challenge has been developing targeted treatments that show a long-term benefit for patients while accommodating the cost of widespread molecular testing in the NHS.
Cancer Research UK are preparing to launch an ambitious UK clinical trial for non-small cell lung cancer (NSCLC) called the Matrix trial which tests multiple drugs in multiple groups of patients. Each treatment has been developed to target precise genetic faults, which we’ll be testing for using our specialised ‘next generation sequencing’ system developed specifically for the programme. Our All Wales Genetic Laboratory here at Cardiff and the Vale is one of just three UK laboratories that will be providing the specialist genetic testing that will determine which drugs the lung cancer patients will receive.
Recruitment starts during Autumn 2014 from across the whole of the UK – we expect to recruit 15-20 patients to each of the 16 treatment arms. Additional treatment arms may be added as new therapies linked to genetic markers become available. If a treatment shows promise, then there’s the potential for that arm to break off from the main trial and grow into a larger independent trial with more patients who share that genetic profile.
Early evidence suggests that this genetic approach to the treatment of lung cancer will have a significant impact on patient outcomes.
There’s hope for you.
Picture credit: Diego Torres Silvestre