Professor Bryan Hennessy:

I thank the Chairman and members of the committee for inviting us here this morning. I am the clinical lead of Cancer Trials Ireland and I am joined by our CEO, Eibhlin Mulroe. We are delighted to be here to discuss the implementation of the research-related key performance indicators of the national cancer strategy. We also want to raise awareness of the value of clinical trials in cancer treatment.

I am a consultant medical oncologist, a professor of medicine at the Royal College of Surgeons in Ireland and an adjunct professor in the division of cancer medicine at the University of Texas MD Anderson Cancer Center.

Cancer Trials Ireland is a charity that was set up by doctors, nurses and scientists in cancer care to work on trials across cancer disease areas. There are over 500 members and we come together regularly to develop ideas and set up cancer trials. We have 130 cancer trials under way in Ireland, which involve thousands of patients. The trials are how we develop new and effective cancer treatments.

Ireland has the know-how to do more trials. By increasing investment in cancer trials infrastructure, we will be offering Irish cancer patients more options and potentially better outcomes. Cancer trials can extend lives and improve quality of life. When I am in the clinic with a cancer patient, there are times when I want to be able to offer more than the standard of care and that is where a trial can help. Due to the resource constraints in our cancer units and at our head office, there are trials we simply cannot do at the moment.

Cancer is a genetic disease caused by changes in DNA that can be inherited but most of which arise randomly during a person’s lifetime. The landscape of cancer trials globally is changing as we move away from treatments based on the previous understanding of cancer site of origin such as lung, breast or pancreatic cancers, and more towards targeted studies where we look for the same DNA change or mutation in a variety of cancer types. These trials are very specific, with smaller patient numbers, and are replacing the larger one-size-fits-all trials that we had done in the past. Ireland can and does participate in these new types of trials, which are important for patients. In such trials we are testing whether certain targets in cancers respond to specific new treatments in the context of trials where the patients are monitored at the highest level.

As for our recommendations, we need to take steps to implement the national cancer strategy published in 2017. The previous strategy in 2006 was a game changer for cancer care. We in Cancer Trials Ireland believe this strategy could also be a game changer for cancer research. Many members will be aware that we need to be ready to take on the challenge of a twofold increase in the incidence of cancer on the island of Ireland over the next 20 years. In that context, fostering a research culture in our hospitals is important and will create more treatment options for patients through our activity. The target - KPI 20 in the national cancer strategy - to double the number of people with cancer who can access cancer trials, from an estimated 3% to 6% by 2020 would have saved the HSE millions of euro in drug costs and would have provided more patients with access to promising new treatments that would otherwise not be available. Because of cuts to our funding, however, we are actually going in the wrong direction. In 2018 the numbers we have collected so far suggest only 348 patients were newly recruited to cancer trials in 2018 and according to the last report by the National Cancer Registry Ireland, NCRI, there were 22,321 new cases of cancer in the same year. In 2014, the equivalent figure was 664 patients on trials and approximately 21,000 new cases of cancer, which led to calculation of the 3% baseline figure.

In order to support the national cancer control programme, NCCP, achieving this key performance indicator, KPI, and other research related KPIs, Cancer Trials Ireland is calling for support from this committee to reverse the 20% funding cut to its Health Research Board grant that supports its cancer trials research units and general central office. We need an additional €1.2 million per year to Cancer Trials Ireland research units and central office over the next three years to increase activity and to bring patient numbers up to and above the 3% baseline for persons recruited to clinical trials. We need protected time for clinicians and medical teams so they can do more research and foster a culture of research in our hospitals.

We recommend that the NCCP makes available a ring-fenced fund to which cancer trials research units can apply for multi-year funding for staff and capital to ensure continuity and to build up human capital in each unit. While the Health Research Board grant covers costs it is not sufficient funding to provide a stable platform for individual research units to do more.

I will hand over to my colleague, Ms Eibhlin Mulroe.