Cancer in a time of COVID – how UCL is keeping vital research and treatment on track

In the midst of a third national lockdown, researchers at UCL Cancer Institute have had to rethink the way they work to avert a further public health catastrophe.

“We mustn’t give up on cancer – it certainly hasn’t given up on us”.

So says Professor Tariq Enver, Director of UCL’s Cancer Institute, which has remained open throughout the COVID-19 pandemic to keep vital clinical research going amidst the closure of UCL’s wider campus.

Facing unprecedented disruption to funding streams, material resources and clinical capability, simply keeping the Paul O’Gorman Building – home of the Institute – operational was far from easy. But, Professor Enver adds, doing so demonstrates UCL’s commitment to patients, and the world-leading and unique cancer research capacity that will impact so many of their lives.

In partnership with Cancer Research UK, the Institute is home to one of the largest cancer trials centres in the UK. Its critical role in tackling such a profound health issue makes it unthinkable that its work should stop for a year or longer, he says.

Supporting cancer patients

“Through UCL Partners, we support around eight million patients, in a mixed area of London with immense under-privilege. We had to keep going so that patients could continue to receive the best and most advanced care, and so that we wouldn’t be starting from zero after the pandemic recedes.”

“"Cancer itself remains an ongoing pandemic – we cannot afford to slow down.” Professor Tariq Enver

Professor Enver’s words are borne out of projections – released by UCL at the outset of the first lockdown – which suggest that there could be an additional 18,000 cancer deaths in England attributable to the effects of coronavirus.

In response to such a stark outlook, researchers quickly adapted long-established ways of working so tasks such as computational research could be achieved from their homes. However, lab-based work had to take place at the Institute. With low occupancy strictly enforced in order to ensure social distancing, those on-site were able to maintain remarkable levels of productivity.

Continuing clinical trials

Urological cancer specialist Professor Gert Attard leads one of the teams that has kept its vital work going under national restrictions. His research into prostate cancer has identified a ‘fingerprint’ in the blood that provides an early signal that the disease is active and spreading, meaning doctors can assess how advanced a person’s cancer is and determine the best course of action.

Knowing how important the work is to clinical trial participants, he and his team were determined to continue processing the donated samples which would otherwise have been disposed of.

“Samples come to us from across the country,” Professor Attard says. “The flexibility and support of UCL made it safe and feasible for lab work to be done, and we kept going thanks to the extreme dedication of staff, who recognised patients’ wishes to be on the trial and didn’t want to waste their samples.

““What we managed was small compared to what we normally do, but it was important nonetheless.” Professor Gert Attard

Professor Adele Fielding, one of the leads for the UK’s clinical trials programme for acute lymphoblastic leukaemia, agrees that finding a way to continue was the right course of action.

Her lab receives specimens from across the UK for patient-specific tests to detect minimal residual disease – small numbers of leukaemia cells that remain in a person during or after treatment. Each test is unique to an individual’s tumour, and closing the lab would mean adult patients whose sample had been lodged with UCL would not get access to testing.

“We were driven by the realisation that, if our work stopped, there was no chance that these patients could be helped,” she says.

Working through a series of lockdowns is complex. The team needs to manage access to buildings when the majority of the campus is closed and ensure the safety of its personnel in the lab – but also to access reagents amidst a huge surge in global demand owing to COVID-19 testing programmes. As a result, one member of the lab was re-assigned to purchasing supplies on a full-time basis.

“It didn’t reduce the level of specimen testing we are able to do, but it was much more work to do it,” Professor Fielding says. “Despite the challenges, it is an absolute pleasure and gives the team an additional sense of purpose during a terrible time.”

““I’m very proud of the lab for pulling together so effectively.” Professor Adele Fielding

Supporting the response to COVID-19

As well as keeping its research up and running, the Cancer Institute has also found new ways to support UCL’s rapid contribution to the broader national effort against COVID-19 through testing and research; for example, tackling the issue of blood clotting that some coronavirus patients experience.

“We’re good at looking at blood,” says Professor Enver. “So we were able to apply our blood cancer expertise to one of the main effects of serious infection that made so many patients go on ventilation. Thanks to a state-of-the-art cell sorter – acquired through a philanthropic donation – we were able to work out why the immune system is causing these big problems.”

The Institute also diverted its antibody engineering expertise to COVID-19 research, drawing on two decades of innovation in developing antibodies to fight cancer. By creating a unique ‘cocktail’ of recombinant antibodies, this treatment could block the virus from entering cells and remove it from circulation – vitally important for cancer patients, who are often more vulnerable to COVID-19.

But whilst utilising its considerable knowledge to tackle the virus, the Institute has been proactive in raising awareness of how cancer research and treatment has been affected by lockdowns and the focus on COVID-19. It published its first analysis in April showing that the UK could see at least 20% more deaths over the following 12 months in people newly diagnosed – finding a 76% decrease in urgent referrals and a 60% decrease in chemotherapy appointments.

Building back

“Of course it is right to tackle COVID but cancer remains a major issue and the impact on patients will become evident over the next year,” says Professor Attard. “We’re in the process of rebuilding to get back to where we were and get momentum going again, but the reality is that research has been put back by months and patients have been hit badly by not being able to access their normal treatment.”

There are other reasons that the long-term effect of the pandemic on cancer care and research is weighing heavily on those at the Institute.

Funding for the research that is creating better therapies and extending lives is a particular and urgent source of concern. Clinical trials are funded for a particular period, Professor Attard explains. “So when something stops for five months, where do you get that time back? Funders don’t have five months of extra funding to add on.”

This is only one aspect of the greater challenge of cancer research funding in the UK, which has been decimated by the effects of the pandemic. Cancer Research UK – the charity which facilitates over 50% of all publically funded cancer research nationally – is projecting a decrease in fundraising income of £300m over the next three years.

UCL receives around 40% of its research investment from the charity, meaning that its work is highly exposed to the knock-on effects of such a drop.

“It’s a desperate situation,” says Professor Adele Fielding. “Charities are a huge mainstay of cancer research funding and the continuation of basic research relies on them. The impact will be felt everywhere, from research and clinical trials to training.”

““There could be long-term implications for this country’s life-saving research and translation capacity.” Professor Adele Fielding

UCL is urgently looking at how it can maintain investment in its flagship research centre so as to ensure the continuation of short term clinical trials involving real-world patients, nurture the exceptional researchers, clinicians and professional staff of tomorrow, and rebuild the resilience of our research in the face of this and potential future funding shocks.

Professor Enver shares his colleagues’ deep concern. However, he is determined not to lose the extraordinary momentum the Institute had built up prior to the pandemic.

“Now more than ever we need to keep this amazing show on the road,” he says. “We can move quickly for as long as we have the funding to do so. We are not giving up on cancer patients and we won’t let them be forgotten. Our vision and commitment hasn’t lessened; we are still researching, still treating, still striving.”

Though COVID-19 has changed much of the world as we knew it, it has not yet altered the promise of another future – but we must act now to save it.

Find out more about supporting cancer at UCL