In vitro diagnostics and disease detection have never been as current as during the coronavirus pandemic, with daily updates issued on COVID-19 testing capacity, test availability and infection levels in the UK and around the globe.
This is all to the good for a medtech industry segment whose contribution to population health and wellbeing is often merely accepted as a matter of routine. The coronavirus has shone an intense light on the role of testing during the pandemic, but with that comes another risk: that other diagnostic activity can be pushed to one side.
This observation is made by NHS England chief medical officer Chris Whitty in a new report by Cancer Research UK (CRUK) that stresses the transformative effect of earlier diagnosis on outcomes, improved quality of life and survival.
CRUK's Roadmap For Cancer Diagnosis
"Early Detection and Diagnosis of Cancer ̶ a Roadmap to the Future," released on 6 October, recommends more funding to research and develop the technology innovations that will yield “new models of health care that engage patients meaningfully.” This requires coordinated action across a range of sectors and organizations, said Whitty in a foreword to the report.
The UK’s Cancer Problem
Cancer remains the leading cause of death in the UK, say the CRUK report, and the UK also has lower survival than in comparable countries around the world, as well as significant variation in outcomes across the UK.
Yet patients diagnosed at stages 1 and 2 have the best chance of curative treatment and long-term survival. NHS England’s Long Term Plan identified this, and made a commitment to detecting 75% of cancers at an early stage by 2028.
But this aim cannot be met through better implementation of known cancer diagnostics alone, said the CRUK report. R&D to bring in new, impactful early detection and diagnosis approaches is vital.
COVID-19 has had an impact on the early detection and diagnosis (ED&D) ecosystem. Reacting to the pandemic is important, “but so too are many other health priorities – and these have not gone away,” said Whitty, who is also chief scientific adviser for the Department of Health and Social Care.
One of these priorities is cancer ED&D and its potential for the UK and globally. “We should not allow COVID-19 to stop the progress that was being made and the ambition to go further,” he said.
Whitty chaired the steering committee that established 14 actions across four broads themes to create the UK diagnostic roadmap. The actions include:
A longitudinal study of a cohort of individuals with very early or precancerous lesions to find factors that predict progression, and developing detection and prognosis technologies;
Developing mechanisms to risk stratify the population, through genomic or other means;
Understanding who is most at-risk, whether the early cancers/pre-cancers detected will progress, and helping to minimize the risk of overtreatment;
Using e-health records and artificial intelligence/machine learning methods to deliver assessments of cancer risk in early symptomatic patients; and generating novel AI risk stratification technologies for ED&D in asymptomatic individuals;
Evaluating wearables for real-time monitoring and risk management;
Devising a health economic model to confirm the economic viability of ED&D, which would attract investment in the sector;
Establishing a Health Innovation Incubator that would assist start-ups with initial seed investment and resources;
Creating a platform for the validation and evaluation of new diagnostics in cancer referral pathways in hospitals; and
Setting up a national body on evidence assessment for ED&D pipeline products in the UK and globally.
These actions embody the shared vision for ED&D across of all stakeholders, including industry and investors, said the CRUK report. It was issued shortly after NHS England released its own report, delayed by COVID-19, calling for radical investment and reform of diagnostic services, as recognized in the NHS Long Term Plan of 2019.
The UK Association of British HealthTech Industries (ABHI), which contributed to the CRUK report, has increased it outreach into the diagnostics sector in recent times. It developed its own UK diagnostics roadmap strategy document after a meeting in June of the government-industry Health Technology Partnership (HTP). The roadmap was favorably received by the government, said ABHI chief operating officer Nishan Sunthares. (Also see "MHRA’s Lee To Give UK Medtech Industry Greater Diagnostics Focus" - Medtech Insight, 14 Sep, 2020.)
The association has continued to target efforts to develop a resilient and scalable diagnostics industry. Recently, it broached themes of how to move to earlier, more complete diagnosis models across the UK with health minister Lord Bethell, former health minister Lord O'Shaughnessy and Regius chair of medicine at the University of Oxford, Sir John Bell.
The focus must be on partnership, said Sunthares, to facilitate earlier diagnosis, while using the lessons from COVID-19.