Affordable Approaches to Cancer

Affordable Approaches to Cancer logo highlights the UK and India research challenge

Scientific Remit

Bilateral teams will be able to apply to tackle one of our research challenges. All proposals must:

  • Build on the complementary research strengths in both India and the UK
  • Address a cancer of high unmet need in India, the UK and/or globally
  • Clearly address the key theme of ‘affordable approaches to cancer’
  • Aim to produce outputs that are readily translatable to patients
  • Be innovative and involve multidisciplinary work e.g. proposals that utilise affordable technology alongside biomedical research
  • Be feasible within the constraints of the funding and time available.

For further information please read our Seed Funding Remit and Eligibality guidelines. 

Download the remit and eligibility guidelines

The call for seed funding applications will be open on Monday 2nd September 2019. 

The grants process for this initiative will be managed by our implementation partner, the India Alliance, with support from Cancer Research UK and the Department of Biotechnology. A link to the seed funding application page will be provided when the call opens. 

Research Challenges

Identify and quantify cancer risk factors to better understand regional variations, enabling new approaches to cancer prevention

Context

In 2018, there were 18 million new cases of cancer worldwide. India accounted for over 1 million of these and the UK, just over 400,000. While there are significant differences in the age-standardised incidence rates of different cancers between these countries, substantial heterogeneity also exists on a regional level within countries.

In 2016, in India, it was estimated that there was variation between states of 3.3-11.6 times, for the four most frequent cancers - lip and oral, breast, lung, and stomach. Similarly, in 2015, age-standardised incidence rates showed that women in the North East of England are almost twice as likely (1.9 times) to get lung cancer as women in the South West of England.

Part of this variation may be explained by variations in known risk factor prevalence. The remaining part, however, is still unexplained and may be due to novel, undiscovered risk factors. The wide variation in age-standardised incidence rates across India provides researchers with a rich resource to understand the differences.

Aims and opportunities

The aim of this challenge is to explain the large variations in incidence of specific cancers, particularly those common in India, by identifying new cancer risk factors, as well as quantifying established risk factors.

In both India and the UK, information on cancer risk factors such as family history, reproductive history, place of residence (which can be used to infer air pollution exposure), physical activity, occupation, chemical and pesticide exposures, diet, anthropometry, alcohol use, and use of tobacco and smokeless tobacco is not routinely collected in cancer patients.

There are opportunities to inexpensively collect this data from patients at first presentation or diagnosis, but it needs to be standardised and shared to examine the contribution of these risk factors to the geographic variation of specific cancers. 

New and innovative affordable approaches and technologies are needed which can rapidly acquire, store and share information on potential cancer risk factors in a confidential manner, and in India, to acquire the information from patients who speak different languages in a broad variety of contexts.

When addressing this challenge, proposals should articulate how an improved understanding of regional differences in cancer incidence could lead to new or enhanced approaches to cancer prevention in India, the UK and globally.

Impact and affordability

Cancer risk factor discovery and quantification of known risk factors is the first necessary step to the development of cancer prevention programs that are locally optimised. Identifying and quantifying cancer risk factors will provide policy-makers with information on measures to reduce cancer incidence and provide the public with accurate information on reducing their personal risk of cancer.

Devise affordable screening tools to improve early detection of cancer

Context

For many common cancers survival triples when a patient is diagnosed at an early stage. It is recognised that early detection of cancer leads to treatments with improved survival outcomes but also less toxicity. In the UK, 46% of people present with late stage cancer, and in India this is as high as 60%.

In 2016, the Indian government published an operational framework for the country’s first national cancer screening programme for oral, breast and cervical cancer. The UK currently has three national screening programmes, for bowel, breast and cervical cancer.

Despite these advances, population-based early detection tools are either not that effective or are expensive. Existing tools can be insensitive, resulting in missed cases, and non-specific leading to false-positives, over-treatment and an economic health burden.

Current screening tools also face issues around poor uptake in certain demographic and socioeconomic groups. Reasons for this include, but are not limited to, a lack of education on the importance of early detection, myths/stigma about cancer screening and/or reluctance to attend screening appointments, particularly in women, for privacy reasons. There are also particular challenges in India in terms of access to screening, given that 80% of the population live in rural areas.

There is therefore a need to develop and/or evaluate affordable early detection tools for cancer. These tools also need to be usable in a wide variety of contexts/ settings, as set out below.

Aims and opportunities

The aim of this research challenge is to devise affordable screening tools for the early detection of cancer that will result in a stage shift in diagnosis leading to better survival in a large population of cancer patients.  

Tools which exploit recent technological advances, can be used in low resource settings i.e. are robust and easy to use in both rural clinics and tertiary hospitals and are, where relevant, less invasive, have the potential to have an enormous impact on survival in India and the UK.

Tools could include those used either in a field-based setting or at home. New approaches that make current screening methods more affordable is also in scope. Evaluation of new technologies which have already been devised is also in scope.

Impact and affordability

Having affordable and less invasive tools to detect cancer earlier will have a significant impact on survival, better quality of life for patients and economic benefits to society, not only in India and the UK but globally.

Identify affordable approaches to improve early diagnosis of symptomatic cancers

Context

Almost two-thirds of patients with cancer in India present at the late stages of the disease; in the UK, this is just under half. Diagnosing and treating patients while their cancers are still at an early stage has the potential to not only improve survival but also to improve the outcome of treatment at a lower cost.

In both India and the UK, there are a range of reasons for late diagnosis, including a lack of awareness amongst the general public as well as primary care physicians. In India in particular, myths about cancer being incurable are also prevalent.

In the UK, a number of studies over recent years have developed greater understanding of the underlying causes of late diagnosis and built an evidence base around which interventions can deliver a stage shift in a UK context. Despite this progress, in both countries, there is an urgent need for concerted efforts to improve early diagnosis of patients with symptoms and signs of cancer that will lead to better outcomes.

Research is required to understand which interventions are effective in different contexts and how they can be delivered cost effectively at scale.

Aims and opportunities

This research question aims to identify approaches to improve early diagnosis of patients with symptoms and signs of cancer. The lack of previous systematic attempts, particularly in India, to educate the public and primary care physicians on early diagnosis means there is an urgent need to test several approaches, using both conventional tools, as well as modern technology.

Approaches could include: assessment of novel diagnostic pathways; developing targeted information and tools for primary healthcare professionals; and/or using digital platforms to raise public awareness.

The effectiveness of specific interventions might be different in different regions of the country, depending on the sociocultural context. Approaches could be tested in varying socioeconomic situations to identify the most effective strategies.

Early diagnosis research seeks to understand the role of patients, healthcare professionals and healthcare providers, and to develop interventions in a population or clinical context. It can include population, behavioural and policy research. This is not to be confused with early detection research which seeks to enable the detection of cancer, or pre-cancerous states, at the earliest possible time point at which an intervention might be made.

Impact and affordability

Creating a shift of stage at presentation in patients with cancer will have high impact on reducing cancer mortality and will optimise scarce healthcare resources and funds. Targeting early diagnosis in symptomatic patients has the potential for considerable stage shift, at low implementation costs, and would translate to superior outcomes of treatment. This is also likely to have a major socio-economic impact as most patients could continue to contribute to society by remaining gainfully employed.

Develop computational approaches that can reduce the cost of cancer care delivery

Context

A well-functioning health system is crucial if we are to meet the future needs of our populations and improve cancer outcomes. Artificial intelligence solutions have revolutionised many areas by enabling rapid decision making and predictive interventions using big data sets. These technologies must be exploited for rapid, efficient and effective cancer care delivery.

In both India and the UK there is a significant lack of key professions such as radiologists, endoscopists and pathologists in our health systems. Being able to rapidly analyse and interpret large patient data sets is a key approach to ensure health systems, which lack resource, can meet demand.

Aims and opportunities

The aim of this research challenge is to develop effective methods to rapidly analyse big patient data sets to best inform clinical decisions in under resourced health systems. Developing these mechanisms will enable access to diagnosis and personalised treatment planning for multiple types of cancers and, as a result, improve cancer outcomes.

A huge amount of patient data is available in digital form at different stages of the cancer pathway, and there are opportunities to leverage existing data sets from India and UK. These data can be patient-specific demographic information, family history of cancer, radiological images, results of diagnostic, pathological and biological tests, surgical and non-surgical interventions, post-treatment follow-up data and population statistics.

Examples of the broad range of opportunities for using this data are listed below:

  • Develop artificial intelligence and deep learning-based approaches to identify affordable, effective early diagnosis and/or treatment approaches
  • Develop algorithms that help in treatment planning using retrospective data
  • Develop algorithms that are robust to missing data
  • Transfer learning models from one cancer to another, one population to another
  • Develop efficient heterogeneous data integration and semantic linking approaches to speed data collation and analysis

These opportunities can increase productivity of healthcare workers in tertiary hospitals but could also be used in more remote areas where healthcare workers are under resourced and facing additional pressures.

Impact and affordability

Both India and the UK have health systems which are under considerable pressure, with efficiency savings and funding gaps being a regular occurrence. If we are to improve cancer outcomes, we need to bridge the gap in our healthcare delivery systems, and collate and analyse data, using affordable (intelligent) tools.

Critically, consolidating and standardising clinical data from cancer patients will allow healthcare workers in under resourced settings to help decide which treatments will work best for their patients and improve their cancer outcomes.

Finding new, affordable ways to target hard to treat cancers using small molecule treatments

Context

New cancer treatments are being developed by the pharma industry, but the process of bringing these drugs to the market is slow and expensive. The traditional model for drug discovery is costly and as a result produces drugs with a high price tag. The majority of these drugs are unaffordable, particularly those patients and health systems in LMICs. Additionally, there has been limited research and/or success in developing treatments for hard-to-treat cancers which have a high prevalence in LMICs.

New, innovative and affordable approaches to drug discovery are required, particularly for difficult-to-drug targets in hard to treat cancers, for example, oral, gall bladder, oesophageal and nasopharyngeal cancer.  

Aims and opportunities

The aim of this research challenge is to find affordable approaches to drug discovery in hard to treat cancers. Cancers that are currently hard to treat could benefit from a bilateral approach between India and the UK where existing knowledge, expertise and samples are leveraged in both countries.

Affordable approaches could include, but are not limited to:

  • Repurposing of small molecules that have either already been marketed, or have a defined mechanism of action, to use as new anticancer treatments 
  • Taking advantage of the medicinal and synthetic chemistry expertise in India to reformulate existing molecules both to optimise the treatment and to avoid existing patents
  • Using artificial intelligence, in silico, phenotypic and target-based drug discovery capitalising on unique libraries in India and UK, with a view to screen these against patient specific models

Support could be leveraged from an industrial partner

Impact and affordability

Bringing forward new, affordable treatments for cancers such as oral, gall bladder, oesophageal and nasopharyngeal cancer would have an impact in India and the UK, but also globally. Allowing new cancer treatments to be introduced relatively quickly and at low cost, would meet the needs of patients and healthcare payers alike. Targeted small molecule approaches can be delivered as an out-patient without the necessity for post-hospital intensive treatment.

Improve the affordability of effective cancer treatments

Context

Efficient use of healthcare resources is a world-wide challenge and the demand for cancer treatment is increasing. Many standard cancer treatments have been developed in high-income countries and their affordability and practicality has not been evaluated in other healthcare settings.

The causes of cancer, types of cancers and healthcare systems in countries such as India are different compared to high-income countries. The administration of healthcare within India is also complex and largely unregulated, adding the additional complexity of public and private healthcare providers.

Aims and opportunities

This research challenge aims to optimise the affordability of effective cancer treatments, encompassing the major treatment modalities, to improve cancer outcomes.

Example therapeutic questions include, but are not limited to:

  • Chemotherapy: Do shorter or alternative treatment schedules provide similar or better outcomes with less toxicity?
  • Immunotherapy: How can we make immunotherapy more affordable? 
  • Radiotherapy: How can technology increase the efficiency of radiotherapy delivery? Are there opportunities to use hypo-fractionated regimens or novel radiosensitisers to deliver treatment more efficiently?
  • Surgery: Can alternative surgical techniques be developed that have superior outcomes to existing ones, reducing further downstream costs? Can novel intra-operative imaging improve surgical resection outcomes, making surgery more efficient?

Impact and affordability

Making cancer treatments more affordable would have a significant impact on the accessibility and delivery of cancer therapy and cancer outcomes.

Develop approaches to improve long-term quality of life in children and young people with cancer

Context

In the UK there are around 4,500 new cancer cases in children and young people every year; in India this is around 50,000. For this group, treatment is usually received at a time when patients are still growing and developing. This can often lead to long-term side-effects including infertility and hearing loss, as well as short-term side effects typically experienced as part of cancer treatment (e.g. hair loss). As a result, there are still many children and young people that have been treated for and survive cancer, but who lack a good quality after care.

Research is needed that addresses the long-term side effects of treatment for children and young people who survive cancer.

Aims and opportunities

The aim of this research challenge is to develop new tools, approaches or treatments that cause fewer long-term side effects and/or improve the quality of life of young cancer survivors, their families and/or the community they live in. This could include methods that have physical, psychological and/or economic benefits.

There is potential for this challenge has application across multiple tumour sites, as well as global relevance.

Approaches could include but are not limited to: developing and/or evaluating treatments which cause fewer long-term side effects or, developing affordable devices/technology which can tackle the long-term physical and/or psychological effects that children and young people who survive cancer face.

Impact and affordability

Developing approaches to improve the long-term quality of life of children and young people who survive cancer could not only have a positive and significant impact on the cancer survivors and their families but could also have a broader economic gain (e.g. fewer follow-ups could result in a reduction of healthcare costs, or low-cost tools would be more widely available for those who need them most, particularly in LMICs).

Our Partners

Cancer Research UK is delighted to be partnering with the Indian government’s Department of Biotechnology (DBT) for this initiative. The DBT, under the Ministry of Science and Technology, Government of India, was formed in 1986, giving a new impetus to the development of the field of modern biology and biotechnology in India. 

Cancer is a global epidemic that requires radical new approaches through inter-disciplinary and multi-national efforts. The Affordable Approaches to Cancer initiative will provide a catalysing platform for scientists and researchers in the UK and India to co-create solutions for affordable cancer care that improve cancer outcomes around the globe. At DBT our priority is to apply science to solving complex challenges that benefit all humanity and we are glad to be partnering with CRUK to support research across all stages of cancer from prevention to cure to address the formidable challenge of cancer.

Dr Renu Swarup, Secretary of DBT

Get in touch

For queries regarding the Affordable Approaches to Cancer Initiative or if you require help finding potential collaborators for your application please contact Dr Debbie Robinson here.

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