Innovation in treatment and care
Treatment and care for cancer patients is becoming increasingly advanced. For example, surgeons can now perform operations with much greater precision, and therapeutic vaccines are being developed to prompt the patient’s immune system to fight cancer. Work is also being done on better early diagnostics, and much greater attention is being paid to quality of life after recovery.
The earlier tumour cells are dealt with, the better. At LUMC lecturer Wilma Mesker in the Surgery department is searching for ways to detect cancer sooner. ‘You might say that we’re looking for a tumour’s signature,’ she says. ‘In blood there are indications that a tumour is growing in the body, even at a very early stage. We are focusing on the proteins that are produced by the tumour, or by the body as a reaction, that find their way into the blood. To do this we use mass spectrometry, a technique one can use to identify molecules. The sooner a tumour is found, the more effectively the patient can be treated, with better chances for survival.’ The test is currently undergoing trials on a national scale on individuals who are genetically predisposed. Mesker hopes to eventually develop a simple blood test that can be administered by one’s family doctor.
‘We continue to learn about the important role played by the immune system in cancer patients,’ says Sjoerd van der Burg, professor of Immune Therapy at LUMC. ‘For instance, for some time now chemotherapy has been used to kill cancer cells, but it is only in this century that we have learned that it also has an effect on the immune system. It turns out that chemotherapy sometimes stimulates one’s defence system against the tumour. We are now studying how we can boost this positive effect.’
Van der Burg is working on a therapy to fight types of cancer caused by the human papillomavirus (HPV). He is studying whether a therapeutic vaccine triggers an immune reaction against cells damaged by HPV. This experimental medicine has been tested on patients in early stages of vulval cancer. A number of them were completely cured. The same vaccine proved incapable of provoking a strong immune reaction in patients with cervical cancer, but that will soon change. ‘One of the things we look at is how we can combine this vaccine with chemotherapy to produce the strongest possible effect on a tumour that has already developed,’ according to Van der Burg.
Making tumours glow
With most forms of cancer, an operation remains an important component of the treatment. ‘When people are cured of cancer, that is practically always because we have done a good job of removing the tumour,’ says Rob Tollenaar, professor of Surgery. Surgical techniques are constantly improving, with techniques like fluorescence-guided surgery. Leiden researchers are developing fluorescent materials that attach to tumour cells, making the tumour light up and enabling the surgeon to remove it very precisely. They are also looking for substances that make vital tissues more visible, such as nerves and blood vessels. ‘Thanks to these developments, in the future we will be able to perform more effective operations with less damage to healthy tissue,’ comments Tollenaar.
Brachytherapy, an internal radiation technique, also aims to spare the tissue surrounding the tumour as much as possible. During the operation, the source of radiation is brought as close as possible to the tumour, killing the cancer cells with only minimal damage to the healthy cells. These techniques are already being used in patients with gynaecological tumours. The question as to whether patients suffering from rectal cancer would also benefit from brachytherapy is currently being studied.
Leiden is leading the nation in evaluating care outcomes. ‘It’s not only a question of whether the operation went well; it also concerns other outcomes that matter to the patient, such as whether the patient’s sexual functions are still intact, and whether the patient can still take the dog for a walk, for example. That’s what we call value-based healthcare,’ says Tollenaar. He is one of the initiators of DICA, an institute that tracks healthcare outcomes. LUMC is heavily invested in e-health, healthcare utilising digital technologies. He gives the example of the phone consultation, where the patient doesn’t have to come to the hospital, but interacts with the physician over the telephone or Skype.
Dutch Institute for Clinical Auditing