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Managers guide to cancer support

Guidance to help you manage when cancer affects your team

Supporting your team through the most challenging times

For most people, cancer will be life changing.

It affects people in both their personal and professional lives. Someone with cancer might be dealing with the effects of treatment as well as the cancer itself. Understanding what employees are dealing with can help you support them better.

Cancer in the workplace resources

Supporting people affected by cancer at work

Our experts talk about cancer, its impact and ways to support people affected by it in a series of videos.

Transcript

Who are you?

Hi.

My name's Dr. Tim Woodman.

I'm one of the medical directors at Bupa UK Insurance

where I've been working now for 13 years.

Before I came to Bupa, I was a GP in the NHS,

and I worked in the NHS for about 30 years or so.

At Bupa, I'm responsible for looking at the care

that we provide to our customers who are living with cancer

to help them get better diagnosis, better treatment,

and better all around care.

And to take my mind off of all that stuff

and all the doctoring, I'm really interested in food

and drink, both the consumption and the production,

and also military history because my dad was in the Navy

and my granddad was in the cavalry.

So I find it all quite fascinating.

What is your medical background?

So I trained as a GP.

I qualified an awfully long time ago, back in the 1980s.

As part of my general practise work, I took a lot

of interest in people with cancer

because services weren't very good in those days.

I've worked for some time in a hospice. When I was a gp.

I also did some work in radiotherapy,

which got me even more interested in cancer.

Since I started working for Bupa,

I've become very involved in looking at new treatments,

new innovations, and talking to specialists

and experts about how they treat manage cancer.

I'm a member of the European Society for Medical Oncology,

so I keep up to date as much as I can to make sure

that I'm able to give really good advice

and support to our customers.

What is cancer and how would you explain this to people without a medical background?"

Cancer is a word that strikes fear into a lot of people,

and a lot of that fear is

because they don't understand what cancer is.

Essentially, our bodies are made up of trillions of cells,

and these cells like people, they're born, they grow,

they die, and all of that is controlled by their DNA.

And I'm sure most people have heard of DNA.

If DNA goes wrong, the cells can go wrong.

That might mean they die,

or it may mean they don't die when they should die,

or they divide more rapidly than they should,

and they multiply and they spread into the

tissues that surround them.

That's what we call cancer. Cancer is a malignant tumour.

It's a tumour that can spread whether it's into the tissue

surrounding the original site

or whether it's throughout the body,

through the bloodstream.

How can we focus on optimism instead of fear when talking about cancer?

Cancer is a word that evokes lots of responses in people,

but the commonest response is fear.

And that fear, sometimes it's fear based on

previous experience of a loved one, living with cancer,

dying from cancer, having a very unpleasant experience

during their treatment with cancer.

And sometimes it's just fear of the unknown.

What is in front of me? What does this mean for the future?

What does this mean for my family, my children, my friends?

Both of those scenarios really need to be

discussed openly in the context of

what is living with cancer Like nowadays, we have very good

treatments, we have very good ways of managing side effects.

We're able to offer a lot of psychological support,

emotional support, care for family,

and other loved ones.

And I think living with cancer can be

a less negative experience if those

processes are put in place.

But also if people are encouraged

to live the best life they can,

cancer will affect one in two of us during our lifetime.

And if you can live your best life

and you could be helped to live your best life, then

that really is the way forward if you're living with cancer.

How has cancer treatment evolved over the past decade in the UK?

So in my experience, I think

that cancer treatment has changed radically worldwide,

and particularly in the UK over the last 10 years.

And the pace of that change is increasing all the time.

There are basically three kinds of treatment

that you could have for cancer.

You don't necessarily have all three, by the way.

So the first of these would be surgery,

and most patients with cancer will have some form

of surgery, whether it's minor or major.

One of the biggest developments in recent years in surgery

has been the use of robots to assist the surgeon.

Using a robot means you don't have big,

painful scars like you used to.

You can be in hospital for a much shorter period of time.

You can lose less blood

and you can recover more quickly following your surgery.

Second form of treatment, which I'm sure a lot

of people have heard of, is chemotherapy.

And chemotherapy again, could be quite a frightening word

because once upon a time, chemotherapy was very toxic.

You were given drugs whose aim was

to destroy the cancer cells,

but they unfortunately tended to have

effects on your own cells as well.

Things like your hair and your blood.

Nowadays we use much more accurate chemotherapy.

It's targeted at particular cells,

so the side effects are less.

And we are using new agents as well that work

with your immune system

to help your body fight the cancer cells.

And we're moving into some really exciting areas in my view

now, such as cell therapies

where you can modify your own cells to work

with your immune system and even cancer vaccines.

The third common treatment, which again I'm sure a lot

of people have heard of, is radiotherapy.

Radiotherapy has advanced in leaps

and bounds, in my opinion.

We're now able to provide radiotherapy over shorter courses.

For example, a course of 25 courses of radiotherapy,

or 25 cycles as we call it, can now be reduced down to five.

This means less interference with your daily life.

The radiotherapy is much more accurate,

so you have less side effects in terms of inflammation,

tiredness, skin damage, and things of that sort.

So the whole treatment arena is vastly different.

What’s the impacts of exercising if I am receiving cancer treatment?

Cancer treatment, particularly radiotherapy

and chemotherapy, can make people feel very fatigued.

Now, that's not the same as feeling sleepy, fatigued is

what my granny would've called bone weariness.

Everything just seems to be a massive effort,

and what you really need to try

and do if you're in that situation,

even though it seems difficult, is to exercise,

even if it's just a short walk, 20 minutes every day.

If you can do that, it actually helps your body

to counteract that fatigue.

The flip side is if you're getting that exercise,

it will help you sleep better,

and a combination of good sleep

and physical exercise will help you build up stamina,

and if you've got more stamina, you're better able to cope

with some of these effects of your cancer treatment,

particularly the fatigue,

which some people can find really unbearable.

What are the most promising developments in cancer treatment?

In my day job, I spend a lot of time talking to scientists

and clinicians, and they're always telling me

what they're working on

and what the next big thing is going to be.

One thing that is going to make a massive difference

to cancer treatment is actually the use

of artificial intelligence so that you can look at

the histories of tens of thousands of patients

and use that information to predict how a cancer is going

to behave in an individual.

And this opens up all kinds of possibilities in

how you can target the treatment towards them.

The other area that is looking very promising

is making better use of the immune system to fight cancer.

The best way of treating any invader to your body is

to use your own immune system.

And there are new agents out there

that can stimulate your immune system.

They can uncloak tumours.

Tumours are very good at hiding from the immune system,

which is why they can progress without being destroyed.

I'm also seeing people coming to me with new advances.

In radiotherapy in particular, the ambition is

that one day people will able to have radiotherapy

in a single shot.

They won't have to keep coming back to the hospital,

and that radiotherapy can be as good as surgery

in some cancers, which again, spares, people being admitted

to hospital and for surgery itself,

people are getting better

and better at removing

tumours very, very accurately.

Robots help with this.

It means there's less tissue damage and less nerve damage.

And for things like prostate cancer

where nerve damage can cause really bad side effects,

this is a great bonus.

So things are coming on in leaps and bounds,

and I think they're going to increase at a great rate.

What's the role of precision medicine in cancer?

Precision medicine is an important new development

because it enables the clinicians to design treatments

that are aimed specifically at your tumour.

When I first started practising medicine,

you'd remove its tumour and say, oh, that's bowel cancer.

Then you'd look at it down a microscope

and you could identify what type of cell it was.

Since we got better at looking at DNA, we've been able

to look at the DNA of the cancer cells

and identify whether there are mutations in those cells

that are causing the cancer to grow

or causing damage to the cells.

And what you can then do is design drugs

and treatments that will target those mutations

and not target other areas in the body.

Using artificial intelligence,

we can now design those agents much more quickly

because it's no longer a process of trial and error.

So the idea is that eventually you'll have a treatment

that targets your cancer and your cancer alone.

We're moving towards that.

When you look at things like cell therapy, where

we can modify your own immune cells in the laboratory

and cancer vaccines where we can use cancer cells

to produce a vaccine in the same way as you could use Covid

to produce a covid vaccine.

So precision medicine is becoming more and more important.

How can genomics and AI help to improve diagnostic accuracy?

Diagnosing cancer has always been difficult

for some cancers because they could easily be hidden.

They're not necessarily a lump or a change in your skin

or a change in your bowel habit or the way you pass urine.

They develop inside your body and they're hard to find.

But what we are now able to do is look for cancer cells,

and particularly to look for the DNA from cancer cells

in your bloodstream, in your saliva.

So we can use that as an initial diagnostic tool

to determine whether you have cancer.

And by looking at those mutations

and putting them through an AI algorithm,

we could even say where that cancer is likely

to have come from, and we could even now start to work out

how we should be treating that cancer.

So the use of genomics

for cancer itself is drastically altering the

way we diagnose cancer.

The other use for genomics is just looking at your whole

gene structure, generally what we call your genome,

because you can look at that

and you can find people who have got mutations

that might make them more likely to develop certain cancers.

Doesn't mean they will, but they're more likely to.

So that could then change what you offer people in terms

of screening tests like cervical smears or mammography.

So again, we could use the genes

to help refine the way we diagnose cancer,

because the earlier you can diagnose cancer,

the more likely you are to be able

to cure it at the first attempt.

How do you see the future of cancer care in the UK evolving over the next 10 years?

I've lived through a lot of changes in cancer treatment,

and I think there are going to be lots more changes

both in treatment but also in cancer care more generally.

I think we're now becoming far more aware

of the impact the cancer can have on people emotionally

and psychologically as well as physically.

We now recognise that there's a definite need

for support in those areas.

There's a definite need

to support people in living a healthy lifestyle because

although it sounds incredibly boring,

even when you've actually developed cancer

and is not too late to change your lifestyle

and a healthy diet, and plenty of exercise has been shown

to help treatment work, radiotherapy in particular seems

to work much better if you give it to people immediately

after they've exercised.

For example, in terms of the actual treatments,

there will be greater use of robots in surgery,

but I think we're also going to be using more

and more targeted precision therapies to the point

where it may no longer be necessary

to actually cut tumours out.

I think radiotherapy is going to get more accurate

and more focused, and it will be able to do a lot

of the jobs that we currently need a surgeon to do.

What we are also able to do now

and will be better able to do in the future is

to shrink tumours down with a combination of drugs

and radiotherapy so that if they do need surgery,

the surgery is much more manageable

and much more likely to result in a cure.

But I think the key in all of this is we are looking

much more holistically at cancer now,

and we'll continue to do so in the future.

What role does AI and machine learning play in cancer detection and personalised treatment planning?

We hear a lot about artificial intelligence nowadays,

and it's moving into the cancer arena in the same

as it's moving into so many other fields.

The great thing about artificial intelligence is it can

absorb a huge amount of information

and use that to formulate an answer.

So for example, if you were to take blood tests

from 10,000 people at the beginning

of their cancer experience

and then look at what the outcome

of their cancer experience was,

artificial intelligence will be able

to tell from that blood test.

It can predict what the outcome was.

So we could use artificial intelligence now

to help us design treatment plans

because we can see how your cancer is likely to develop.

We could also use artificial intelligence

to look at molecular changes, to look at changes in DNA

and to actually model in virtual reality drugs

and treatments to address those particular changes so that

your high precision medicine becomes

high definition medicine.

It becomes much more accurate,

and again, the more we can target the cancer,

the less impact it has on the rest of your body

and on your wellbeing.

Are there specific areas of cancer care where innovations are emerging?

All cancers are not the same.

Unfortunately, some cancers historically have been very hard

to diagnose and even harder to treat.

If you look at cancers such as pancreatic cancer,

which is buried deep in the body, ovarian cancer,

which can have very vague symptoms,

these are often not diagnosed until they've already started

to spread, which means

that survival rates historically have always been very bad.

Now, we're able to use the pancreatic cancer

precision radiotherapy to shrink the cancer down so

that the surgeon is then able to go in

and remove the hold of the tumour.

Whereas if that radiotherapy hadn't taken place,

it would be far too risky to operate on the patient.

With ovarian cancer, we can now use robot assisted surgery

again to do much more accurate operations,

which reduces the risk

of spreading cancer cells around the body.

We're also looking at innovations

in brain tumours.

Brain cancer historically has always been very difficult

to treat once it's diagnosed,

but there are now ways

of diagnosing brain cancer much earlier.

And again, if you diagnose it earlier, you are more likely

to be able to treat it more effectively.

The common of cancers that we all hear about breast cancer

and prostate cancer, the innovations,

there are very much refinements of what we've done before.

So radiotherapy requires fewer sessions.

Surgery is less invasive,

and you're in hospital for a shorter period of time.

And the other cancer that people really worry about is lung

cancer when it comes to the common cancers,

and again, there've now been some new innovations in

how we could diagnose lung cancer at earlier stages,

how we could use artificial intelligence to look at scans

and see more accurately whether

the abnormalities on the scan are cancers

and if they are cancers, how aggressive they are.

And finally, melanoma, skin cancer,

very common cancer, very difficult to diagnose

because it can mimic all kinds of other skin lesions.

We are now using artificial intelligence to analyse

high definition pictures of these skin markings.

These could then tell a specialist with a high degree

of certainty whether this is skin cancer or not,

and whether it needs further treatment.

So innovations targeting lots of cancers,

but particularly it's targeting the ones

that were previously very hard to reach

and very hard to treat.

What do we mean by personalised cancer treatment, and how does it differ from precision medicine?

When we talk about personalised treatment,

we sometimes confuse it with precision medicine,

and there's a lot of overlap between the two.

Personalised treatment means treatment that is

addressing you as a person, like it says on the tin.

So personalised treatment in my head means treatment

that's addressing your wishes, your needs,

your particular circumstances, even your job,

because different treatments have different effects,

and those effects can have different impacts depending on

what your daily life looks like.

Precision medicine is really looking at

what is your cancer?

What can we do to treat your cancer differently

because your cancer isn't the same as somebody's cancer

who lives just down the road?

And that's where we're developing new treatments,

new chemotherapies, things like cancer vaccines

and cell therapies, so you can have precision medicine,

and at the same time, how does that integrate

with your life and your wishes

and your needs so that we can make

that a truly personalised experience as well.

What is genomics and how does it play a role in personalised healthcare?

Genomics is the science of looking at genes,

which doesn't tell a lot of people anything really does it.

Genes are the little bits of protein that tell your body

what to do basically.

So they tell the cells how to grow, when to stop growing,

how fast to divide, whether they're going to become a tooth,

a toenail, or a blood cell.

Personalised medicine

and precision medicine can then look at any changes

in these genes to see whether

or not you're more likely to get cancer,

to see whether the cancer is due

to damaging the genes.

And if so, can we either pull off the shelf a treatment

that will address those changes,

or can we use artificial intelligence to design a treatment

that will address those changes?

Genomics has made a massive difference in

how we diagnose and treat cancer.

We don't have to carry out major surgery to diagnose cancer.

Now, we could use a small amount of blood

or a little bit of saliva

and look at any changes in the genes

that are expressed through that.

Now, by that, what I mean is that all cells in the body die

and break down at some point,

and when they do the DNA,

which is the material in the genes,

comes out into your bloodstream.

So you can identify DNA from cancer cells as well

as DNA from normal cells.

So genomics really looks at the

fingerprints of cancer.

So it helps you diagnose cancer,

but it can then also help you see whether the cancer's come

back after treatment.

Because if you've been round

and bleached the house,

there shouldn't be any fingerprints left afterwards.

But you can use genomics to actually have a look

and make sure there's no more fingerprints

and that you're clear of cancer.

So genomics is very much forming the foundation of a lot

of modern cancer treatment.

How does genetic testing help personalise cancer screening and treatment?

So your body can be identified by its genome,

which is if you like, the complete signature

of all the genes in your body.

And these are the proteins that tell your body how

to grow and how to develop.

And again, there could be signals in

that changes in the genes

that can show whether you have an increased risk

of developing diseases such as heart disease and diabetes.

But also particular kinds of cancer.

And I'm sure lots of people have heard of the BRCA gene,

which is associated with breast cancer and ovarian cancer.

It's often known as the Angelina Jolie gene.

Now, if you have some of these mutations, some

of these gene changes, it may mean you need

to change the screening programme for cancers

because the changes don't mean you are necessarily

going to get cancer.

They just mean you.

You're more likely to, what you could also do

if you do demonstrate these changes

and you then get cancer again, there are precision medicines

that just target those gene changes.

And the Angelina Jolie gene, the BRCA gene,

it's not just in breast cancer, it's also in ovarian cancer,

it's also in prostate cancer.

And there are very specific drugs which could be given

to treat those kinds of cancer

much more effectively than just saying, oh,

you've got prostate cancer,

here's the off the shelf treatment.

So finding these genes when you do the whole genome

sequencing can have a big bearing on how you screen

for cancer and actually how you plan the treatment

of somebody should they actually develop cancer.

What should someone do if they are worried about a symptom?

If you are worried that you might have cancer

or that you have any other physical symptoms

that you're worried about, it's very tempting to go online

and see what's out there, and there is masses out there.

Most of it is not verified.

Most of it is not coming from reputable health

professionals, and you can just make your worries worse

or even find actively harmful information.

There are sites like the NHS MacMillan Cancer Support

Bupa, who have online resources

that have been independently verified to be accurate,

so they can help you to decide whether

or not these are symptoms that are of no concern

or symptoms that you need to seek more advice on.

But if you do need to seek more advice,

if you are a Bupa customer, you can access

bupa's Digital GP services.

You could use the Bupa app to access health advice,

and if necessary, you can get onward referral

for investigation.

But what I think is really important to bear in mind

is the vast majority of the time you haven't got cancer,

the fact that you're worried about cancer doesn't mean you

shouldn't get it investigated,

but most people who are worried they have got

cancer don't have it.

But if there are any worrying signs, it's really important

that we get to the bottom of them as early as possible.

What are Bupa currently offering in the cancer space?

The biggest thing that Bupa offers for any of its members

who are worried about having cancer

or who are actually living

with a cancer diagnosis is our cancer promise.

Now, the cancer promise means that Bupa will be

with you every step of the way, holding your hand

through this whole cancer experience.

This means access to early diagnosis,

often without even needing a GP referral.

Through our direct access service, it means access

to the latest tests.

It means access to the most modern evidence-based

treatments, including some drugs

that may not even be available on the NHS at the moment.

It also includes access to our specialist centres

for the Communist cancers,

and it includes 24 7 access to mental health support

because we know that a cancer experience has

a big emotional impact,

a big psychological impact in addition

to any physical effects.

Now, obviously, not all Bupa products are the same,

so it's really important that you check your level of cover

and speak to Bupa before seeking any kind of treatment.

Can you explain Bupa specialist cancer centres?

Bupa has a network of specialist centres

for breast cancer, prostate cancer, and colorectal cancer.

These specialist centres bring together leading experts

in those particular cancers to ensure

that Bupa members are able to access rapid

diagnosis often without the need for GP referral

through our direct access cancer schemes,

and that they're also able to access rapid reassurance,

which I think is an absolute key feature of these centres.

The majority of people going into a specialist centre

who are worried that they have cancer do not have it.

And obviously the sooner you can offer that reassurance,

the better it is for the customer.

Should they actually not be able

to be reassured straight away.

They will get a confirmed diagnosis

or a confirmed clearance within a very short timeframe.

And if they need further investigations

or if they need treatment, this will be planned,

discussed with them.

Discussed with a multidisciplinary team

and organised again in a very rapid and efficient fashion.

So what we're trying to do

and what we are achieving with the specialist centres

is early reassurance, early diagnosis,

and rapid access to high quality evidence-based treatment

provided by experts in the field.

What cancer pathways do Bupa offer?

In addition to its specialist centres, Bupa offers

other cancer pathways.

For example, there is a remote access

pathway for skin cancer.

This enables Bupa customers

to take a photograph using equipment, which is

provided by Bupa, that is analysed

by artificial intelligence

and then reviewed by a dermatologist, a skin specialist,

who's able to either offer rapid reassurance

that this is not skin cancer

or to arrange referral for further investigation.

And all of this can actually take place

from our customer's own home.

So it's a very efficient, low impact way

of getting reassurance or further investigation.

Another new pathway, which Bupa has recently started up

is for gynaecological cancers.

So these are cervical cancer, cancer of the womb,

cancer of the ovary.

Cancer of the ovary in particular,

can be very difficult to diagnose.

So again, what we're doing is offering rapid diagnosis,

rapid reassurance, and assessment

and treatment by experts in the field

of gynaecological cancer.

So these are just two other pathways that Bupa is able

to offer to its customers who think they might have cancer.

What's the difference between direct access and open referral?

People get confused by some of the terms

that are used in bupa's policies.

So let's break them down a little bit.

Direct access is what it says on the tin.

It means that a Bupa customer is able to access

specialist advice

and care without being referred

by another healthcare professional, whether that's a GP

or an optometrist or another practitioner.

This at the moment, is limited to certain specialties

and particularly to certain suspected cancers.

But what will basically happen is that you contact bpa,

explain your symptoms.

These are assessed against standards

that have been established by nice,

which is the National Institute

for Health and Care Excellence.

So they're known to be robust independent standards,

and if necessary, you could be referred to see a specialist

without any need for any other intervention

by another health professional.

Open referral is a system whereby

consultants agree that they will see Bupa customers

and they will not ask them to pay anything above

what is covered on the Bupa policy.

What this does mean though is

that if you are given a referral by your gp,

the GP can't specify the individual

consultant that you will see.

The GP will write a letter to Dear Orthopaedic Surgeon,

for example, and you will be offered a choice

of open referral orthopaedic surgeons in

your geographical area.

So Bupa doesn't decide who you see.

It offers you a choice,

but these consultants will be within our open referral

network, which means you can feel reassured

that you're not going to get a nasty, unexpected bill

after you've seen the consultant.

So that's basically the difference between those two terms,

which pop up quite frequently in our literature.

What advice would you give to an employer supporting a team member undergoing cancer treatment?

If you're an employer and you have a staff member who's

been diagnosed with cancer

and is undergoing treatment,

this can obviously be quite challenging for both of you.

I think the important thing for employers to remember is

that all cancers are different

and all people have different experiences of cancer.

I often say you can plan the treatment,

but you can't plan the side effects.

So you have to be flexible around the fact that

if somebody says, I'm going to be off for two days,

having chemotherapy every four weeks,

there may well be times in between when they also need

to take some time out due to the side effects

of the treatment, if they're experiencing them side effects

and the general impact of cancer treatment

can be very unpredictable.

So people need to have access, for example, to quiet spaces.

If they're feeling a little bit overwhelmed

by their treatment, they need to have easy access

to a bathroom if they suddenly find themselves feeling sick

or having bowel or urine side effects, for example.

It's also very important as an employer

to really be as empathetic as you possibly can

and to recognise that somebody who's going

through cancer treatment will not necessarily want

to talk about how they're feeling in great detail,

but it's really important that your antenna

are twitching, that you are really aware of the fact that

this person is undergoing

what is potentially a very difficult experience.

So I always think

that the key in these scenarios really is a combination

of flexibility and empathy.

What are some examples of reasonable adjustments that help employees with cancer stay in work?

People who are living with cancer

have different attitudes to work.

Some people really feel that they cannot cope with work

for the whole duration of their treatment.

Other people value the social

interactions that come with work.

They find that work is a distraction from

how they're feeling physically

or psychologically as a result of their treatment.

But they may not want to actually be at work full time,

or they may be at an environment where

it's not completely conducive to the way they're feeling.

If they were a really noisy, crowded office,

they may function better if they're able to have

a quieter space so

that their head is not crowded out

by all the background noise

and they can concentrate through the brain fall,

that cancer treatment could often bring.

Some of the cancer side effects are obviously

potentially embarrassing, sometimes quite unpleasant.

So really, employees need to have access to

secure private bathrooms if they need

to use them at fairly short notice.

I think the other issue is people who are living with cancer

need to be allowed the privacy

to raise their illness in their own way, in their own time,

and at their own pace.

So again, I think it's really important that

the whole subject is approached

with an open mind on both sides.

So it's about transparency, and again, it's about empathy

and it's about flexibility.

But if people who are living with cancer want to work

and they're able to work without their performance being

impaired there really as much as possible,

they should be encouraged to.

What role do clinical trials play in cancer care in the UK?

The thing about cancer is treatments

are changing all the time.

The other thing about cancer is

that we hear about all the common cancers,

but actually there are some cancers that are quite rare

and affect relatively small numbers of people.

So it's very difficult to find new treatments for them,

and that's why it's really important

that we have clinical trials where we test new drugs

either on their own because they are completely new

or against existing treatments to see if they're better.

And in cancer in particular, it really so important that

even when all options appear to have failed,

people are offered the chance to go to clinical trial.

And actually these trials will quite often lead to

significant improvements in the outcome of the cancer

for the people in them.

What is immunotherapy and how does it work?

You've probably noticed that when you have the flu

or a cold, your temperature goes up.

You start sweating, you start shaking.

This isn't the illness. This is your immune system

fighting the illness, and the best way of getting rid

of any illness in your body is fuel immune

that your immune system to attack it and destroy it.

It does this because you have immune cells in your body

that recognise foreign tissue.

Now, cancer cells,

because they arise from your own body, are already

partly invisible to the immune system,

but also they're very clever

in actually hiding themselves even further.

That means the cancer could grow without the immune

system attacking it.

So historically

what we would do if we couldn't cut the cancer out,

or if we couldn't blast it with X-rays,

we would give chemotherapy.

We would give drugs that kill the cancer cells,

but unfortunately they also kill other cells in the body.

Immunotherapy is treatment that

uses the immune system.

Now, it can do that in several ways.

One of the ways that immunotherapy works is by

effectively removing the cloaking

device from the cancer cells.

So it lights them up.

That then means that the body's own immune cells could

attack the cancer cells and destroy them.

These are very effective treatments in those people in whom

they work, but they don't work for everybody.

So another form of immunotherapy is

almost the stuff of science fiction

or certainly would've seemed like it five years ago.

Particularly for blood cancers,

which are notoriously hard to treat.

You use your own cells, your own immune cells,

you take them out and you engineer them

to recognise the blood cancer cells,

and then you put them back in the body and off they go

and they attack the cancer cells and destroy them.

So that's the second form of immunotherapy.

A third form, which is in development,

but is just really starting to show promise

is cancer vaccination.

And that is the same as the vaccination you would have

for Covid, for example, whereby you produce a vaccine

that specifically recognises cancer cells.

And that's something that will be hopefully coming

around in the next few years.

What role does pharmacogenomics play in reducing side effects and improving treatment outcomes?

The use of genomics is something

that has expanded in medicine rapidly in recent years,

and it's starting to provide an answer to one

of the questions that has puzzled us as doctors for ages.

And that is why two people will respond completely

differently to the same drug.

And it may be something as simple as paracetamol.

Some people, it works for other people, it doesn't.

Now, obviously, paracetamol no big deal,

but there are drugs that are far more important

for much more severe diseases,

and we now realise through this new science

of pharmacogenomics that for those drugs

to work, there are particular genes in the body

that have to be present and undamaged,

and then the drugs will work.

If those genes are damaged, the drugs don't work.

And that's really important

because it means you will take drugs

that work if you know which ones don't work.

You can avoid those drugs

that are liable to give you side effects.

And there are a lot of drugs that it's a trade off

between benefit and side effects.

Well, if you're going to have side effects

and there's going to be no benefit,

you could use alternative drugs.

We are starting to try

and expand that to look at drugs for cancer,

and that will be the way forward in the future.

But we're already starting

to see the benefits from pharmacogenomics when we look at

the number of people that don't respond

to common antidepressants in particular,

to common painkillers and potentially to some antibiotics.

What are polygenic risk scores and how do they help predict cancer risk?

We are using genomics more and more.

And the more we use it,

the more we understand the potential that it has.

We know that there are

some defects in genes mutations,

which can cause particular illnesses,

but if you put together those mutations

with other lifestyle factors

and other genes,

so you don't just look at one gene at a time,

you could produce what's known as a polygenic,

as in many genes, polygenic risk score.

And this will tell you your risk of developing diabetes,

heart disease, certain cancers, some forms of arthritis.

It's really important that

people don't think a high polygenic risk score means they're

going to get that illness.

It just increases their risk of getting it.

And what that means is they can take steps to prevent it.

So particularly for things like heart disease

and diabetes, that is a big alarm call

to get your diet in order, sort out your exercise programme

and so on, reduce the modifiable bits

that will then start to reduce your risk for cancer.

The picture is slightly different.

The same modifiable risks apply.

So diet, exercise, alcohol, smoking obviously.

But also we have screening programmes for cancers,

breast cancer and colorectal cancer in particular.

And for cerv cancer.

And if you have a high polygenic risk score for any

of those cancers, you may want

to consider starting your screening earlier.

And in fact, it has been shown that

if you bring screening forward by a few years

for some cancers, it could significantly increase

the rate at which you detect cancer

at a stage when it's treatable.

So polygenic risk scores are really interesting.

New use of genomics,

and I can see them coming into play more and more.

How can businesses promote cancer awareness and reduce stigma around cancer in the workplace?

It can be very difficult, particularly in a large company,

to know the best way of

empowering your employees who may be living with cancer so

that they continue to work normally

and interact normally with their colleagues

without labelling them.

So there are various things you can do,

and one of these in particular that resonates very well

with men is poster campaigns, particularly

in toilets for prostate cancer, but also for bladder cancer.

But you can put similar posters in toilets for any gender

for other cancers such as breast cancer

and colorectal cancer in particular,

you can have awareness events in the workplace.

You could encourage employees

to take up their health assessments so they're aware of just

what it's like to have your health inspected

and just generally lower the temperature,

make it less extraordinary

to be having conversations about cancer and other illnesses.

How can awareness of early intervention be improved in the workplace?

We know that the outcomes for cancer

improve the earlier the cancer is diagnosed and treated,

and the difference could be massive.

If you diagnose cancer at stage one

and treat it for a lot of cancers,

there's a hundred percent chance

that you'll still be alive five years later.

But obviously it's important that we get into

that happy state where we are intervening early,

which means we're diagnosing early.

And employers can play a key part here by

encouraging their employees

to take up health assessments if they're available

to the company, to encourage their people

to participate in screening campaigns when they become

eligible through age, to generally raise awareness

of cancer, to signposts their employees

to reputable sources for advice if they're concerned

that they might have cancer or any other serious illness.

It's just really important without making people

overly fearful that they become more aware of

what is available, if they're concerned about their health.

What do you wish every employer understood about supporting colleagues with cancer?

It is very difficult when you work with people who are

experiencing cancer treatment

because they can come to you hopefully

and explain, this is what's happening to me.

This is the treatment I'm going to be having.

But you can put the treatment in your diary.

They can put the treatment in their diary.

They can't put the side effects in their diary.

They don't know. The main thing about cancer

and its treatment is its unpredictability.

I think as an employer, the biggest thing you can do

for those people is to be alert to that possibility.

Don't roll your eyes

and touch when they say, sorry,

this morning I'm feeling really awful.

Is it okay if I work from home

or actually I'm just going to turn my laptop off

and I'll catch up later on today?

Because they didn't know the day before.

That was how they're going to feel. And actually you don't

want, they'll be feeling, I know from my own experience,

guilty enough that they're not able to do the things

that they would normally be doing,

and they don't want that guilt compounded.

So again, as a good employer,

just be alert to this unpredictability.

Be very receptive so that they feel your

employees feel they can talk to you.

If there are things that need to be worked through

with the HR department, kind of do it in the background.

I had a conversation with my line manager,

funnily enough, as part of a video conversation,

and it was only after that that I realised just

how much had been going on in the background

with the HR department to keep them abreast of my illness,

my treatment, the possibility that I might take time off.

In fact, I took very little off.

I think I took about two weeks off at the end

of my radiotherapy, but that was me.

Everybody's different. Some people might want

to take three months off while they have chemotherapy.

Some people might want to work right the way through it.

So again, as an employer, you just have to demonstrate

and literally walk the walk, show that you're open,

show that you're receptive,

and that you're listening to them accept the fact

that things can be unpredictable in terms

of telling their colleagues about it.

Well, that depends entirely on what the person with cancer,

I want you to tell other people.

It's not your business to go

around telling their work colleagues.

So an absolute no-no is do not have any conversations

about somebody's cancer, and

unless they specifically said that you can

or they've done it themselves.

I circulated all the people I work most closely

with two days after I got my diagnosis.

But that's me again. Other people may not want to do that.

So as all of these things, the keynote to me is always

empathy, acceptance, and flexibility.

Advancements in cancer care to help business

Further resources

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