Team science

Rob Bristow is the Cancer domain lead and University Professor of Cancer Studies at The University of Manchester and Director of the Manchester Cancer Research Centre (MCRC). In this second part of our interview with him he explains why getting cancer team research aligned here will lead to better patient outcomes globally.

Can you explain your concept of ‘team science’?

My background is in developing strong scientific teams with an equally strong focus on answering an outstanding clinical question, like we did in prostate cancer genomics in Toronto. Together with colleagues from multiple disciplines, I built a team that within five years became a global lead in genetic sequencing of localised prostate cancer by leveraging support from people in different research institutes of the university and teaching hospitals.

We married biology and bioinformatics within a clear line of sight to answer a simple but practical question in the clinic: why do some prostate cancer patients fail surgery or radiotherapy and is this due to hidden spread, or metastatic disease, at the time they are diagnosed?

We therefore had a very crisp clinical question which was just as important to specialists in medical oncology, surgical oncology, radiation oncology, pathology and imaging as it was to our own basic science and discovery team.

In order to answer the question as rapidly as possible for patients, you focus all of your efforts together to answering the question. You reverse engineer the science by aligning skillsets and smaller parts of the overall goal. It becomes team science - a team comprising a wide range of professionals with deep knowledge in their own areas who are best placed to answer smaller questions that together leads to answering the big question more efficiently.

What are the advantages of team science working?

Senior and junior investigators work together across different disciplines towards a high-ambition, high-risk common goal. At the same time, it can create opportunities for all investigators to take parts of the project’s discovery as it unfolds to develop their own novel research areas.

If you create the right team, and if you set up the rules of engagement right at the outset in stating your specific global study endpoint, people can go and cherry-pick discovery research so it becomes an exciting effort for everyone involved.

It actually broadens the scope of what is achieved beyond the question that initially brought the group together. It also prevents a solely top-down approach to the scientific team.

Do you think Manchester will be a good centre for cancer team science?

This is a good time to establish multidisciplinary teams that are looking at cancer problems in both a mechanistic and holistic manner. I have observed a real sense of comradery amongst researchers being supportive of this cancer team science model with shared visions to transform health care though new treatments and approaches that are Mancunian by design.

It provides a true conduit to drive forward extraordinary basic and discovery science and hand that over to the clinicians who are awaiting it as ’research acceptors’ to enact the research when actually treating patients. I personally think this is a great approach when dealing with complex patients that have multiple comorbidities in addition to cancer; this complexity can be handled by placing the research into the clinical real-world context.

What are the challenges for creating Team Science culture?

While I personally speak the language of both the scientist and clinician, with a Canadian accent of course, in reality the nature of individual career aspirations, work environments and the pressures of research funding can be very different in these two areas. So the challenge is to find true synergies within the teams.

Growth and maximising the ambition and productivity of the synergies requires mutual respect, defined common goals and frequent meetings identify and agree to the best scientific approaches that could be changing rapidly to keep pace with rapid scientific discoveries.

Creating the environment and opportunities that will facilitate this is key. That’s one of the reasons that I’ve spent several months holding collaborative town hall sessions which enable clinical researchers to interact directly with patients. Together they come up with the ’headline’ that they want to see in three years that summarises their innovation and aspiration for a new way to think about and treat cancer in the clinic.

These meetings are truly defining the research breakthroughs that we want to see here in Manchester. I’m agnostic as to whether the breakthroughs are at basic science discovery level or in the clinic, or whether it’s about preventing cancer or living with it. What I want to see – in a rapid timeframe – are real changes in our patient outcomes driven by our research.

What are the Mancunian ambitions that you’ve spoken about?

These are our ambitions to tackle important problems using all the resources that we have in Manchester and which tell a simple story about what we’re doing that matters just as much to researchers as it does to Manchester patients.

The key is to state the research project in a simple sentence everyone gets; a sentence you could tell someone in an elevator ride.

The town hall sessions might not have worked and could have become complicated, but I’ve been very excited about the new research stories coming out of them that will lead to new multi-million pound grants. The MCRC will initially pump-prime these ideas so that in the space of three years, we will see our science in action. I think that’s the exciting part of this. And given that all the new projects have been peer-reviewed by non-UK experts and reviewed as outstanding, we are headed in the right direction.

Are there any barriers to research being implemented in clinic?

I believe that there is an elephant in the room with regard to how much tackling cancer actually costs, from the research inception to clinical implementation.

The economic cost is extraordinary with more than one trillion US dollars being spent per year. In the UK, where the NHS is in control of what happens in the clinical environment, research outcomes that have potential to positively impact patient outcomes have to understandably pass a very high bar in order for the health service to approve new treatments though the National Institute for Heath and Care Excellence (NICE).

So placing economics in the research pathway early allows us to constantly revaluate many factors that could lead to a cancer research invention being slowed to its endpoint or failing due to lack of cost-effectiveness. 

The bar is set quite high as our research discoveries have to be commercialised and implemented in a format that will work across different UK NHS trusts and globally in different hospitals and healthcare systems.

Working closely with the GMCP’s  clinical pathway leads and Health Innovation Manchester will help define the real world targets for our innovations and streamline the evaluation process so they can be adopted at pace and scale.

The reality is that what works in one country, may not work in another. Our challenge, but also our opportunity, in Manchester is to say yes we’re focused on novel biology and treatments but we’re also ready to test them within an evidence-based NHS system that can be unforgiving to innovations that don’t also save time and money .

Which developing areas of cancer research excite you?

Our new Centre for Cancer Biomarkers will be globally unique and linked to an academic pathology unit to drive our academic biomarkers further into the NHS testbeds.

We host the biggest and best collection of academic researchers assessing blood-based biomarkers in the world, having pioneered this area. This ‘liquid biopsy’ is the future of cancer diagnosis and monitoring. Through this we will find cancer earlier and treat it better.

Additionally, Manchester is among a small group of leading centres pioneering a precision medicine method of treatment, but we are taking a completely unique approach which I’m sure will become a standard of care worldwide; looking for clues about the cancer in the bloodstream, not in the tumour itself.

Manchester is also a scientific leader in the molecular targeting of cancer and early-phase clinical trials, and cutting-edge radiotherapy that will see the opening of the first NHS high-energy proton beam therapy centre in the UK later this year. 

What do you want the impact of cancer research at Manchester to be?

We need to remain focused on specific strengths to be at the international forefront of cancer research.

Our patients can be complex and understanding and tackling this diversity of patient diseases in addition to cancer, and the complexity of cancer itself based on both tumour genetics and the microenvironment, will drive to better outcomes for complex patients who may normally not have a chance to enter a new clinical trial.

I know our research can have a huge global impact. If we can get it right for the NHS and for NICE, and if the magnitude of the difference we achieve with our science is large, then we can change cancer treatment worldwide.

It’s not ‘what is good for the Manchester is good for the UK’, but ‘what is good for the Manchester is good for the world’. We want to say this is the Manchester way of treating patients, based on rapid and effective discoveries using team science with a one Manchester approach.

The idea that we can change things, by adding value to programmes in a creative and multidisciplinary way is why it’s so exciting to be here every day.