Why Brexit is dire news for research into cancer
A vote to leave the EU would lead to decreased funding for studies to fight the killer disease as well as diminished international cooperation, writes Queen's University's Professor Mark Lawler.
Cancer is the leading cause of premature death in more than 50% of European countries. In the UK, more than half our citizens will develop cancer at some stage during their lifetime, with a significant proportion of patients dying of the disease.
As the debate on a potential UK exit from the European Union (EU) intensifies, with in many cases rhetoric dominating fact, let us examine the ramifications of a Brexit vote through the linked prisms of the cancer researcher and the cancer patient.
Scientists and clinicians in the UK, including Northern Ireland, have made world-leading contributions to our understanding of the complex biology that characterises a cancer cell, and have translated this information into more effective preventative and therapeutic interventions for cancer patients. This is strongly supported both by UK charities (eg Cancer Research UK) and the Government, with a £500m-plus spend on cancer research annually.
However generous this figure might seem, it is not sufficient on its own to support a world-class cancer research effort. Therefore, English, Scottish, Welsh and Northern Ireland researchers compete with cancer researchers from other EU countries in order to expand the "funding footprint" in UK universities and research institutes.
The results have been impressive. In the EU 7th Framework Programme (FP7), which funded EU research and technical development from 2017-2014, more than €1.5bn was spent on cancer research. UK cancer researchers were extremely successful, being involved in more than 80% of funded projects.
If we consider all research in FP7 and not just cancer, more than £4bn of funding was achieved by UK researchers, with Northern Irish scientists and clinicians gaining a considerable slice of that pie.
Looking in more detail at one programme in particular, the highly sought-after European Research Council grants, which recognise individual scientific excellence, UK researchers have clearly punched above their collective weight, with a success rate of 16.5% and a collective value of €150m, placing them in Europe's premier league of researchers.
Thus, there are significant positive financial and reputational benefits for UK scientists and clinicians being part of an EU-wide cancer research effort.
A second positive that underpins cancer research in the UK is the ability of researchers to be mobile. At both junior and senior level, many talented researchers relocate to the UK, bringing a depth and diversity of experience that enhances our universities and research institutions - including Queen's University, Belfast and Ulster University. And this mobility is bi-directional, with UK researchers moving to EU research institutions to develop their careers and contribute to EU cancer research activities.
From a clinical perspective, the ability to work together at EU level has been extremely beneficial, as it allows the identification of best practice and its adoption in different member states. UK researchers have contributed to this shared learning by leading cancer survival surveillance initiatives, such as Concord, and by strong participation in Eurocare. From a Northern Ireland perspective, the Northern Ireland Cancer Registry contributes significantly to both of these initiatives.
Cancer experts in Northern Ireland also participate in, and in many cases lead, pan-European clinical trials that allow the benefits of the latest knowledge and breakthroughs in cancer research to be passed directly on to our patients. However, while enhanced cancer care has led to significantly increased survival in the UK in the last 20 years, there is still room for improvement. And this can best be achieved by sharing best practice.
Thus, for example, recent Danish activities aimed at enhancing earlier cancer diagnosis are now informing potential practice-changing activities in the UK, while innovation to improve outcomes for older cancer patients, such as that ongoing in France, will also help improve UK practice for the ageing cancer population.
Emphasising the importance of the patient, UK patient advocates and healthcare professionals, under the leadership of researchers at Queen's University, Belfast, have come together with their EU counterparts to form the European Cancer Concord, culminating in the launch of the European Cancer Patient's Bill of Rights in the European Parliament in Strasbourg on World Cancer Day 2014.
However, not all EU activities that impact on cancer research and cancer care in the UK have been positive. While the intention of the 2001 European Clinical Trials Directive may have been to promote harmonisation across the member states and simplify regulations, its implementation actually led to an overwhelming increase in bureaucracy, a doubling of costs and an initial reduction in clinical trial activity across the UK.
More recently, the new EU General Data Protection Regulation has provoked significant concerns on its potential (albeit inadvertently) to undermine clinical and translational research. Given these issues, it is critically important that there is a UK voice at European level to address these concerns.
So, what would happen if next week, on June 23, the UK voted to leave the EU? Given that a country has never left the EU before, it is probably safe to assume that a period of uncertainty would arise. So, how would this uncertainty manifest itself from a cancer perspective? From a financial point of view, what would happen to the EU funding that UK researchers so successfully compete for?
It is extremely unlikely that continued access to these funding sources could be renegotiated, thus losing a huge resource that would help to foster better cancer care. Additionally, a prolonged period of economic uncertainty could have significant repercussions on health budgets, which could translate to poorer health outcomes, particularly for the disadvantaged members of our community.
Lack of free movement of researchers would potentially stifle innovation. The benefits of the various EU collaborative approaches outlined above would surely be compromised if the UK's role in Europe were to change. A lack of involvement in EU debate and decision-making would also mean that the powerful voice of the UK in health and research policy would be lost.
Initiatives such as the Queen's University, Belfast-led European Cancer Patient's Bill of Rights, which mean so much to cancer patients across Europe, would be much more effectively implemented through the involvement of the UK within the EU.
It is incumbent on us as global citizens to ensure that, whatever the result of the referendum, we continue to contribute to the European debate in important domains such as clinical trials, data-sharing and clinical best practice, while also delivering the highest-quality research that leads to the best possible outcomes for cancer patients in the UK, the EU and globally.
These aspirations can most effectively be achieved if the UK stays within the EU.
- An article addressing these issues, co-authored by Professor Mark Lawler and Queen's University, Belfast Vice Chancellor, Professor Patrick Johnston, was recently published in the journal Lancet Oncology (Selby PJ, Lawler M, Banks I, Johnston PG, Nurse P, The EU: what's best for UK cancer research and patients? Lancet Oncol 2016; 17: 556-557)