Clinical trials

There is a need to improve accessibility to research and clinical trials within the NHS. Key groups are consistently under-represented in research: those from minority ethnic backgrounds, those with lower socio-economic status and those with impaired capacity. This leads to inequality of healthcare and an inequality of patient experience. Increasing access to research would not only broaden research opportunities and bridge gaps in health equality; diverse research representation means better understanding of disease mechanisms and greater generalisability of findings across the patient population. There are well described socio-economic issues across the region that this trust serves within Cheshire and Merseyside. This brings health challenges for patients. Clatterbridge Cancer Centre is a large networked cancer centre serving Cheshire and Merseyside using a hub model. Research is a core strategic theme; it is hugely important that it is understood not only the areas and hotspots of cancer across the region, but also that patients with those cancers can access a portfolio of research that serves a distinct patient need. Currently there is a lack of such triangulated information within the Trust, which may mean that patient need remains unmet. Therefore the research is designed to understand any barriers that patients may have in accessing research, in tandem with a demographic review and mapping of patient referral and access to the current trials portfolio. This will lead to a truly patient centred approach in accessing research.

LBCL is a cancer of the lymphatic system where B-cells (a type of white blood cell) experience uncontrolled growth. The standard treatment for LBCL is a combination of chemotherapy and immunotherapy, referred to as chemo-immunotherapy. Currently, the best results in the treatment of LBCL is with a chemo-immunotherapy combination called R-CHOP or Pola-R-CHP. Full doses of treatment are not suitable for elderly or frail patients due to potential to cause side effects and heart problems. Such patients either receive a reduced dose called mini-R-CHOP or receive alternatives (e.g. R-GCVP or R-CEOP). Additionally, some patients treated with R-CHOP or Pola-R-CHP may not respond or may respond initially before relapsing. For these patients, treatment is not standardised, and practice varies between hospitals. ALMANAC aims to collect data about the management and outcomes of patients with LBCL who are unsuitable for standard treatments because they are not well enough to tolerate the side effects or because they have not responded or relapsed following initial treatment. In doing so, it will guide research into LBCL leading to a better understanding of this condition and better outcomes.