RM Magazine - Winter 2021 by The Royal Marsden

RM M A G A Z I N E WINTER 2021

SAFE AND SOUND How Helen puts patients at ease on the MR Linac

Liquid assets: detecting cancer DNA in the blood Our complementary therapy service

EXECUTIVE NOTES

CONTENTS 4 Bulletin What’s happening around The Royal Marsden 12 Bright young things Meet three budding healthcare professionals inspired by their Royal Marsden experiences

At The Royal Marsden, we deal with cancer every day, so we understand how valuable life is. And when people entrust their lives to us, they have the right to demand the very best. That’s why the pursuit of excellence lies at the heart of everything we do.

14 Blood will tell Could liquid biopsies mean faster cancer detection and better treatments? 18 A day in the life With MR Linac radiographer Helen Barnes 20 Pioneering digital

pathology

How we’re taking a high-tech approach to pathology 23 It happened to me Carine Bryer, mum of threeyear-old leukaemia patient Reid 24 ...And relax How complementary therapies can benefit our patients 26 Fundraising News from The Royal Marsden Cancer Charity 28 Breaking the barrier Researchers make advances in tackling childhood brain cancer 29 Foundation news Updates from our Foundation Trust and Governors 30 Puzzles and prizes Test your wits and win a prize with our crossword 31 Stay in touch Your comments on social media, plus hospital contacts

ON THE COVER Helen Barnes, Therapeutic Radiographer

WELCOME to the winter 2021 edition of RM, the magazine for our staff, patients, carers and Foundation Trust members. In this issue, you can read about our brand-new Integrated Pathology Unit, which is using artificial intelligence to uncover crucial clues about tumours (page 20). The Royal Marsden is at the forefront of innovations in radiography, delivering treatment tailored to each patient’s individual needs. We are one of only two NHS hospitals in the UK to provide treatment on the high-tech MR Linac. Therapeutic Radiographer Helen Barnes guides us through her role working with this specialist technology (page 18). We are also one of the early pioneers of liquid biopsies, contributing to and leading innovative research that has made it possible to offer personalised treatments and detect relapse earlier for a variety of cancers (page 14). Also in this issue, you can read about the work of our Complementary Therapy team, whose holistic approach of delivering massage, clinical aromatherapy and reflexology helps provide comfort, relaxation and autonomy to patients as they navigate their treatment journeys (page 24). I hope you enjoy this issue.

Dame Cally Palmer, Chief Executive, The Royal Marsden

Some photographs in this issue were taken prior to the COVID-19 pandemic and may not reflect current social distancing and PPE guidelines

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B U L L E T I N W H AT ’ S H A P P E N I N G A R O U N D T H E R O YA L M A R S D E N

Test and learn

LIQUID BIOPSIES ARE tested by scientists at The Royal Marsden’s Centre for Molecular Pathology to help us detect cancer and track treatment response in patients. A blood sample is analysed for small traces of genetic material that is released from cancer cells into the bloodstream, known as circulating tumour DNA. The test, using the state-of-the-art NovaSeq 6000 sequencing machine, can tell us whether patients are likely to relapse, and can identify genetic mutations that could help us personalise treatments. Read more about our work in liquid biopsies on page 14.

? DID YOU KNOW? The trolley service run by the Friends of The Royal Marsden, Chelsea, which provides snacks and drinks to patients and visitors, has now returned to some clinical areas.

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IMMUNE RESPONSE Dr Samra Turajlic measured cancer patients’ antibodies

Virus risk revealed THE LARGEST STUDY of cancer patients’ response to COVID-19 vaccines, funded by The Royal Marsden Cancer Charity, has found that they are at particular risk from new variants of the virus. In two papers published in Nature Cancer, the findings of the CAPTURE study support the Joint Committee on Vaccination and Immunisation’s decision to offer immunosuppressed adults, particularly those with blood cancers, a third primary dose of vaccine. Researchers measured the levels of ‘neutralising’ antibodies – which block different strains of the virus and differ from the antibodies that are routinely measured – in 585 patients with various types of cancer who had received two doses of the vaccine. They found that 83 per cent of patients who had not previously

been infected with the virus developed neutralising antibodies against the original strain of SARSCoV-2, which is the strain current vaccines were designed to target. However, only 31 per cent of patients with blood cancer and 62 per cent of patients with solid cancers had antibodies able to neutralise the Delta variant. Dr Samra Turajlic, lead author and Consultant Medical Oncologist, said: “This study provides evidence that variants of concern pose a greater threat to some patients with cancer. We urge that all cancer patients have their third dose and continue to take precautions to protect themselves.” The study was supported by the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London. RM magazine 5

BULLETIN

‘Search and destroy’ treatment hits target

EVEN BETTER CARE FOR OLDER PATIENTS With the support of RM Partners, The Royal Marsden’s cancer alliance, the Trust is developing a Senior Adult Oncology Programme (SAOP) to deliver personalised care plans for older people with cancer. With half of cancer incidence occuring in people aged 65 and above, we need to do more about the management of cancer in older people. For example, some patients can withstand more intensive treatment with fewer complications, while some may require an adapted treatment plan to minimise the risk of complications. This results in some being undertreated and others overtreated. The SAOP team includes an oncologist, an advanced nurse practitioner, a physiotherapist, an occupational therapist, a pharmacist and a dietician, working with psychologists, speech and language therapists, and palliative care, pastoral care and community services. The service has been implemented in the Breast Unit in Sutton for breast cancer patients over 70 requiring systemic anticancer therapy and a more comprehensive and personalised approach. It will be gradually expanded to include patients with all types and stages of cancer who need systemic therapies such as chemotherapy. 6 RM magazine

? DID YOU KNOW? We’ve installed new hearing loop systems on the pharmacy reception desks at both hospitals.

A HIGH-TECH TREATMENT for prostate cancer that delivers a targeted dose of radiation to cancer cells can keep patients alive and healthy for longer. The ‘search and destroy’ treatment could shrink tumours while leaving healthy cells unharmed and may change the current standard of care for some men with advanced prostate cancer. The results of the Phase 3 VISION trial – led by an international group including

“It’s like a guided missile, seeking out cancer cells”

researchers at The Institute of Cancer Research, London (ICR), and The Royal Marsden – were presented at the American Society of Clinical Oncology (ASCO) virtual annual meeting in September. Study co-author Professor Johann de Bono, Professor in Experimental Cancer Medicine at the ICR and The Royal Marsden, said: “This new treatment acts like a guided missile – seeking out cancer cells with high levels of prostate-specific membrane antigen on their surfaces. “It combines a potent radioactive medicine with a ‘homing signal’ that searches for tumour cells and binds to them, delivering radiation precisely to destroy the cancer.”

TO BE PRECISE Professor Johann de Bono

Awards recognition for four hospital projects Congratulations to the teams involved in four projects that were shortlisted for Health Service Journal (HSJ) awards this year. The intensive care unit (ICU) and palliative care teams were finalists in the HSJ Patient Safety Awards’ End of Life Care Initiative of the Year prize for the ICU Triggers screening tool. This identifies ICU patients who could benefit from earlier access to palliative care, leading to a 46 per cent increase in referrals in the project’s first year.

At the HSJ Value Awards, SUMMIT – the upper gastrointestinal team’s scheme to provide diet and exercise support to patients before surgery, which reduced postponements by 60 per cent in its first year – was shortlisted for Specialist Service Redesign Initiative. Also, the Cancer Surgical Hub was up for Cancer Care Initiative of the Year, while the Perioperative Pharmacy Optimisation Pathway was cited in the Pharmacy and Medicines Optimisation award.

COULD TWO DOSES BE THE FUTURE?

LESS IS MORE Professor Nicholas van As led the PACE-B trial

Five-dose radiotherapy course safely treats prostate cancer ADVANCED RADIOTHERAPY TECHNOLOGY can be used to safely deliver higher doses in fewer sessions to treat prostate cancer with minimal side effects, according to the results of a Royal Marsden-led global trial. PACE-B compared the long-term toxicity outcomes of prostate cancer patients receiving stereotactic body radiotherapy (SBRT) and those receiving standard radiotherapy. Dr Alison Tree presented the data at the European Society for Radiotherapy and Oncology (ESTRO) Congress in Madrid in August. It found that, two years after treatment, nearly 90 per cent of patients experienced only minor side effects, while 99 per cent were free of severe side effects, suggesting that shortened treatment can be given without risk of significant long-term toxicity.

SBRT – which The Royal Marsden delivers via two CyberKnife units, an MR Linac and several standard radiotherapy machines – allows clinicians to precisely target tumours. It involves five high doses of radiation over one to two weeks, while standard radiotherapy courses comprise more moderate doses over a longer period – usually around 20 sessions, which can take up to one month. Professor Nicholas van As, Medical Director and Chief Investigator of the study, said: “It’s reassuring to see from this trial that SBRT does not significantly impact patients’ quality of life, compared with the current standard of care. Using SBRT would mean that patients could be spared numerous visits to hospital, allowing them to get back to their lives sooner.”

Our researchers are now investigating whether men with prostate cancer can safely receive radiotherapy in even fewer and larger doses. Patients on the HERMES trial will be randomly selected to undergo either five doses of SBRT over 10 days, or two higher doses over eight days. All patients will receive treatment on the pioneering MR Linac, which combines radiotherapy with an MRI scanner. Dr Alison Tree (above), Consultant Clinical Oncologist and leader of the trial, said: “We have considerable experience with five-dose SBRT, so delivering treatment over two, larger doses is the next step. “Previous work has shown it is theoretically possible to deliver two-fraction SBRT on the MR Linac, and studies have shown that brachytherapy [internal radiotherapy] administered in two fractions is a safe option for patients with localised prostate cancer.”

“This treatment would mean that patients could be spared numerous hospital visits” RM magazine 7

BULLETIN

NEW EMERGENCY HOSPITAL PLANNED FOR SUTTON Plans are under way to build Epsom and St Helier University Hospitals’ new Specialist Emergency Care Hospital (SECH) next to The Royal Marsden in Sutton. The SECH would provide accident and emergency, critical care, non-elective surgery (including wards and supporting imaging/pathology) and maternity services. There is also an opportunity to create a dedicated cancer surgery space in partnership with The Royal Marsden. The Trust has been working with Epsom and St Helier and other partners to develop the plans. Our staff and patients will benefit from access to a full critical care unit, with more surgery capacity for patients in Sutton in brand-new facilities.

Want to know more? Learn more and have your say at esthplanning.co.uk

NEW PLANS An artist’s impression of the Specialist Emergency Care Hospital

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New insights could help predict treatment response

RISK REDUCTION Miss Jennifer Rusby

Prevention is better than cure A LOCAL BREAST CANCER prevention project is aiming to inform and empower women to make lifestyle changes to reduce their risk of developing the disease. Breast cancer is one of the most common cancers in the UK, but of the 5,000 cases diagnosed each month, it’s suggested that around 23 per cent are preventable. The PIONEER study is recruiting more than 200 patients aged between 30 and 60 who have been discharged from The Royal Marsden’s symptomatic breast clinic, or women

in the same age range who have been identified through the family history clinic. Participants are invited to set lifestyle goals and will complete tests and questionnaires at various points to understand what changes they can make to help reduce their risk. Miss Jennifer Rusby, Consultant Oncoplastic Breast Surgeon and co-lead for the study, said: “This study could shape breast cancer risk reduction for future generations. Our aim is to understand what is most likely to help women adopt

lifestyles that will give them the best chance of avoiding being one of the 23 per cent of preventable cases. “Moving forward, we want to find ways of drastically reducing that percentage by sharing what we learn from the pilot study group and then applying that to a significantly larger national study group.” The PIONEER study is one of several research projects in The Royal Marsden’s new Early Diagnosis and Detection Centre, which aims to speed up diagnosis and improve patient outcomes.

RESEARCHERS AT THE ROYAL MARSDEN, the Francis Crick Institute and University College London have found immune cell patterns in tumours that can help predict whether patients with kidney cancer will respond to immunotherapy. Treatment for clear cell renal cell carcinoma – the most common type of kidney cancer – often includes immunotherapy, but it does not always work and there is currently no way to predict whether it will be effective in an individual patient. Results from the ADAPTeR trial, published in Cancer Cell journal, suggest that an increased number of specific ‘clonal’ T-cell receptors – proteins on the surface of T cells that appear in the tumour before treatment – was linked to a greater chance of a positive response to immunotherapy. Researchers analysed 115 tumour samples from 15 people with metastatic clear cell renal cell carcinoma who received the drug nivolumab. They found that if the T-cell receptors were maintained during treatment, T-CELL TRIAL The research could help us understand why immunotherapy works in some patients but not others

this was the strongest indicator that the drug would be effective. Dr Lewis Au, co-lead author and Clinical Research Fellow at The Royal Marsden and the Crick, whose role is supported by The Royal Marsden Cancer Charity, said: “In people who responded to this immunotherapy, there is a group of T cells that appear to have already recognised the tumour. These cells, with potential tumourkilling activity, are sitting on the tumour, but they need the drug to kick them into action.” The ADAPTeR trial is sponsored by The Royal Marsden and partly funded by the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London, and Cancer Research UK.

“These T cells have tumourkilling potential, but need the drug to kick them into action”

Our work on show at ESMO Researchers from The Royal Marsden and The Institute for Cancer Research, London, discussed exciting breakthroughs at the 2021 European Society for Medical Oncology (ESMO) Congress in September. Results from the Phase 1 FRAME study, presented by Dr Susana Banerjee, suggest that a new combination of the targeted drugs VS-6766 and defactinib could shrink tumours in about half of patients with advanced low-grade serous ovarian cancer. Responses in patients who had a mutation in the KRAS gene were even more promising. Meanwhile, Professor Kevin Harrington’s CheckMate 651 trial has shown that the immunotherapy drugs nivolumab and ipilimumab in combination extended the lives of some patients with advanced head and neck cancer, compared with the standard treatment of two chemotherapy drugs and a targeted antibody treatment.

“This study could shape breast cancer risk reduction for future generations” RM magazine 9

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IN BRIEF

– in partnership with The Institute of Cancer Research, London, as part of the NIHR Biomedical Research Centre and working with RM Partners Cancer Alliance – aims to speed up diagnosis and improve outcomes for patients. Q What AI projects are you working on? A This winter, we hope to open the AI-SONAR study to explore AI approaches to lung nodules on CT scans in patients who have been previously cured of cancer. Our aim is to see whether this can improve the early diagnosis of both relapsed and new lung cancers, to improve treatment prospects and long-term outcomes.

Nursing award

Filipe Carvalho, Advanced Nurse Practitioner (above), has won Bowel Cancer UK’s Gary Logue Colorectal Nurse Award after being nominated by his colleagues. The judges were impressed by Filipe’s quality of care and leadership when he helped to set up and run The Royal Marsden’s Cancer Surgical Hub, which allowed cancer patients to get the surgery they needed at the height of the pandemic.

National role

Dr Richard Lee, Consultant Respiratory Physician and Champion for Early Cancer Diagnosis, has been appointed as the NIHR’s national cancer lead for screening, prevention and early detection. Dr Lee will combine this role with his existing responsibilities at The Royal Marsden.

Driving refunds

Patients who drive to hospital to receive treatment in a car that does not pass the ultra-low emissions standard are eligible to receive a refund. The new Ultra Low Emissions Zone (ULEZ) came into effect in London in October. Ask your clinical team how to apply for a refund if you have been charged.

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Q&A: EARLY DIAGNOSIS AND ARTIFICIAL INTELLIGENCE Dr Hardeep Singh Kalsi, a Clinical Research Fellow funded by The Royal Marsden Cancer Charity and member of the Early Diagnosis and Detection Centre team, on the potential of artificial intelligence Q How might artificial intelligence (AI) improve the early diagnosis of cancer? A AI is used to perform complex decision-making processes that are normally carried out by humans. For example, it can be used to learn important features in imaging or to read medical text. This means we can develop new tools that navigate large amounts of data and support or even improve decision-making during cancer diagnosis.

AI does this by finding patterns in clinical scans and records that identify patients who might be at increased risk of cancer, or by automating triaging of test results to alert clinicians sooner. It can also be applied to identify pre-cancer states and cancer subtypes, and to predict clinical behaviour, including risk of relapse. Imaging and AI is a key theme of the Early Diagnosis and Detection Centre, which

“AI can identify patients at increased risk of cancer or predict relapse”

Q What other benefits might AI offer? A Sometimes, scan findings are labelled ‘indeterminate’ and need to be repeated to watch for changes or concerning behaviour that might indicate cancer or another disease, which can be stressful for patients. AI may enable earlier diagnosis and so reduce anxieties. It may also help reduce the number of scans and appointments needed, freeing up valuable healthcare resources. Q What are your hopes for the role and use of AI? A We hope patients will help us find ethical and valuable AI approaches that lead to ‘learning’ healthcare systems. It would be fantastic if earlier diagnosis remains one of our core strengths in this area. We hope our studies will provide a springboard to share such research on a wider scale to benefit all patients.

Myeloma relapse delayed

Radiology reporting pilot

DRUG COMBINATION Dr Charlotte Pawlyn

A FOUR-DRUG combination therapy has shown promising results for newly diagnosed myeloma patients. Dr Charlotte Pawlyn, Consultant Haematologist at The Royal Marsden and Leader of the Myeloma Biology and Therapeutics Team at The Institute of Cancer Research, London, co-led an analysis of the Myeloma XI+ trial. The first Phase 3 study of its kind, it looked at the effectiveness of the novel drug carfilzomib in combination with lenalidomide,

cyclophosphamide and dexamethasone for patients with newly diagnosed disease. Researchers found that giving this drug combination before a stem cell transplant could delay the cancer’s return. After three years, 65 per cent of patients given twice-weekly intravenous infusions of carfilzomib as part of combination therapy had not seen their cancer progress. The results have been published in the journal PLOS Medicine.

Tim Young, 68, patient on the Myeloma XI+ trial

A PATIENT’S PERSPECTIVE

“I joined this trial at The Royal Marsden in 2015 after being diagnosed with myeloma and have had an incredibly positive outcome. “Following carfilzomib treatment and a stem cell transplant, I’m now back doing the things I love, like sailing and spending time with my daughters and grandson. “I always felt actively involved in all the decisions made while being on the trial, and I’m very grateful to the teams who looked after me.”

? DID YOU KNOW? We’ve revamped the Compton Garden in Sutton to create a relaxing, colourful space that enhances the wellbeing of all who use it.

Mint Lesion, a new type of radiology reporting software, is being piloted for clinical use at The Royal Marsden, following success in trials. The technology allows radiologists to create multimedia reports, which are used by clinicians to guide their decisions when planning treatment, and automatically stores data, enabling easy access for research purposes. Consultant Radiologist Dr Joshua Shur (above) said: “Traditionally, radiologists write reports on a computer simply using text. However, this technology provides more detail for clinicians as it allows radiologists to create graphical reports by embedding images of the tumour and facilitating communication of imaging findings. We are also exploring if patients find these infographics helpful.”

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BRIGH T YOUNG T HINGS

“During my time in hospital, I decided I wanted to study medicine so I could help people when they needed it most”

Since it opened in 2011, The Royal Marsden’s Oak Centre for Children and Young People has treated hundreds of young cancer patients. We speak to three women whose experiences of treatment and care at the centre in their youth have inspired them to take up careers in healthcare

“Working at The Royal Marsden is a dream come true... I credit the nurses with my decision to change career” Emma Godwin Staff nurse at The Royal Marsden “I first came to The Royal Marsden in January 2013 aged 23, when I was diagnosed with

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Hodgkin lymphoma at my local hospital. I was treated with 12 rounds of chemotherapy over six months and responded well. When my scan confirmed I was all-clear and didn’t need further treatment, I was ecstatic. “I really wanted to give back to the NHS, so two years later, I decided to go into oncology nursing. At this point, I had experience in retail and fitness, with a two-year waitressing stint in Canada. Transitioning into healthcare was scary, but it felt like the right time.

“As a patient, all the nurses at The Royal Marsden were amazing with me. I really credit them with my decision to change career. I always felt supported and able to contact them about any worries I had. “There’s also such an incredible atmosphere at the hospital. Everyone I know who has been treated here says the same. “Since September, I’ve been working as a staff nurse in The Royal Marsden’s Robert Tiffany Ward. Working at the hospital is a dream come true.”

Zoe Coleman Junior doctor at Aintree University Hospital “Back in December 2011, when I was 14, I noticed a lump on my neck. I was diagnosed with Hodgkin lymphoma and referred to The Royal Marsden for treatment, which included two rounds of chemotherapy. “During my time in hospital, I had the chance to think about what I wanted to do with my life. I decided I wanted to study medicine so I could help people when they needed it most. Seeing how hard the doctors and nurses worked

for each patient really brought it all together for me. “After I finished treatment, I saw my consultant for a follow-up appointment while I was doing my A-levels. We talked about my future, and I mentioned that I was thinking of studying medicine at university. She put me in touch with Professor David Cunningham, Director of

“Ever since I first walked through The Royal Marsden’s doors, I’ve wanted to go into children’s nursing”

Maisie Carpenter First-year student nurse at the University of Surrey “When I was 11, I was diagnosed with chronic myeloid leukaemia. I was referred to The Royal Marsden by my local hospital – and ever since I first walked through its doors, I’ve wanted to go into children’s nursing. “I was treated with tyrosine kinase inhibitors for eight years. Unfortunately, these drugs stopped working last year, so I had a stem cell transplant – my amazing little brother donated his cells. “While the experience has sometimes been scary,

Clinical Research, who arranged work experience for me. I had the opportunity to shadow junior doctors in the hospital on ward rounds, in clinics and in meetings, which solidified my ambitions. “I have just qualified as a junior doctor and moved to Liverpool to start my career. Next year, I’ll be cancer free for 10 years, which feels amazing.”

I’ve always found the appointments and learning about my different treatments fascinating. I ask the staff lots of questions and I’ve built up my knowledge of cancer and care over the years. “I’ve also met so many inspirational nurses in the hospital. They’re all so kind and supportive – it’s like having a second family. “I think my experience of cancer will help me as a nurse, as I know what patients and their families are going through. I’d love to work at The Royal Marsden once I qualify.” RM

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LIQUID BIOPSIES

BLOOD WILL T ELL

OVER THE PAST five years, the development of liquid biopsies at The Royal Marsden has provided our clinicians with an innovative new tool that allows them to tailor cancer treatments and detect relapse in patients before they experience symptoms. Our experts are increasingly using the technique for patients at various stages in their treatment and for different cancer types, including breast, lung and colorectal. It is now being trialled to assess whether therapeutic treatments are effective and to improve patient diagnosis. Liquid biopsies involve analysing blood samples to detect small fragments of genetic material that tumours release into the bloodstream, known as circulating tumour DNA (ctDNA). When tested in our Centre for Molecular Pathology (CMP), a sample can tell us at an earlier stage if a patient is relapsing, and can identify genetic mutations that could open up new options for targeted therapy.

Pioneered at The Royal Marsden, liquid biopsies allow our clinicians to personalise treatments for a range of cancers and spot recurring disease sooner using a simple blood test

Revealing relapse The Royal Marsden became one of the early pioneers of liquid biopsies when it designed the test that was used in one of the UK’s first clinical trials of the technique. The plasmaMATCH trial examined if ctDNA testing could reveal relapses in breast cancer patients, and laid the foundations for the Trust to use liquid biopsies in other tumour types. The research also enabled us to use the test to determine whether a patient

CRUCIAL TESTS Professor Sanjay Popat (left) and Dr Naureen Starling use liquid biopsies to inform treatment decisions for lung and bowel cancers

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“The potential for using these tests for screening and diagnosis is exciting” RM magazine 15

LIQUID BIOPSIES

“All our new patients have ctDNA tests when they are referred to us, so we can either enrol them onto the Lung Unit’s wide portfolio of clinical trials of targeted therapies or start standard treatment quickly,” he says. “The potential for using ctDNA testing for screening and diagnosing patients in the future is exciting. A blood test could simplify the diagnostic process for lung cancer, as lung tumours are often difficult to reach and identify with a bronchoscopy or biopsy. It could also speed up diagnosis, as a blood test is much more straightforward than the standard diagnostic tests based on cancer tissue.” Sparing chemotherapy The Royal Marsden’s TRACC study, led by Professor David Cunningham, Director of Clinical Research and Development, is looking into whether liquid biopsies

“Thousands of bowel cancer patients a year could avoid chemotherapy” is responding to treatment, as well as in place of an invasive biopsy procedure as a kinder method of diagnosing cancer. Professor Nicholas Turner, Head of the Ralph Lauren Centre for Breast Cancer Research, who led some of these early trials, says: “We know from earlier clinical studies that we can find detectable ctDNA in most patients with breast cancer and identify those who will relapse about a year before it shows up on a scan.

“We can spot breast cancer relapse about a year before it shows up on a scan” 16 RM magazine

“Technological advances over the years have meant that even though a patient may have very low levels of ctDNA, we can use this test to identify mutations in the cancer, giving us the option to use targeted therapies. The next question for us to answer is, can early detection of relapse improve patient outcomes by starting treatment early to try and prevent clinical relapse? “We are also due to open the TRAK-ER randomised trial that uses ctDNA to detect the risk of relapse for patients with ERpositive, HER2-negative breast cancer, who receive hormone therapy for five years following treatment as standard care. There is currently no test available to tell us who will relapse in this

LEADING THE WAY Professor Nicholas Turner

group of patients, so ctDNA may offer us a new way of monitoring them in the future.” Targeting lung treatment The emergence of ctDNA testing has challenged the traditional ‘one size fits all’ approach to treating several cancer types. Liquid biopsies provide clinicians with crucial molecular information to help them tailor treatment without requiring patients to undergo invasive procedures to extract tissue biopsies. According to Professor Sanjay Popat, Consultant Thoracic Medical Oncologist, ctDNA testing is a quicker and more effective way to identify mutation targets than standard tissue biopsies in patients with non-small-cell lung cancer.

could determine which bowel cancer patients need to undergo chemotherapy after surgery. “We know that half of patients with high-risk stage 2 and 3 bowel cancer are cured from surgery alone, but nearly all are offered chemotherapy,” says Dr Naureen Starling, Consultant Medical Oncologist. “Most of our patients opt for chemotherapy as they are worried their cancer will return. “We hope that by looking for ctDNA following surgery, we can avoid patients having chemotherapy if we don’t detect residual disease. This could transform treatment for operable bowel cancer within the next five years, meaning thousands of patients in the UK are spared unnecessary chemotherapy and its side effects every year. “We’re also using ctDNA techniques in the PREVAIL trial to see if we can accurately diagnose patients with signs and symptoms of pancreatic, bile duct, bladder, colorectal, gastrointestinal stromal, or recurrent, difficult-to-biopsy breast cancers. These approaches could revolutionise the way we diagnose, treat and screen our patients in the future.” RM

A PATIENT’S PERSPECTIVE Judith Skepper, 86, lung cancer patient

DISEASE DETECTION Professor David Cunningham leads the TRACC study

“I was diagnosed at the start of the pandemic with stage 4 lung cancer. Professor Popat explained that he used a liquid biopsy to detect that I had a MET mutation, which meant I could be treated with a targeted treatment called tepotinib. “I didn’t even notice I had an additional test – to me, it was just a straightforward blood test. “Unfortunately, my cancer has now progressed and I am no longer on this targeted treatment. However, I consider myself lucky to have had 18 good months on tepotinib, which allowed me to avoid standard chemotherapy and enjoy spending time with my family of three children and 10 grandchildren.”

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A D AY I N T H E L I F E

on the day, whereas most radiotherapy is based on scans taken days or weeks previously. Treatment decisions like this would normally be in a clinician’s remit, but we’ve undertaken training and assessments so we can take on this task. I find having an increasingly direct impact on treatment delivery really empowering, and it benefits the hospital by freeing up doctors’ time. On an average day, I’ll see about seven patients. A key part of my job is to prepare them for treatment, including making sure they are safe. The MR Linac is essentially a giant magnet, so we check for metallic medical devices that could be unsafe, such as pacemakers. Patients also can’t have metal on their bodies and must remove things like jewellery or underwired bras before entering the machine.

A DAY IN T HE L IF E OF

HELEN BARNES THER APEUTIC R ADIOGR APHER

I’VE WORKED AT The Royal Marsden since qualifying as a therapeutic radiographer six years ago. My role involves supporting patients at every stage of their radiotherapy journey, including planning and delivering their treatment. I chose this career as I wanted to be able to give back to the community – and I’m now responsible for providing treatment and care for people through what can be the most stressful part of their lives. During my time at the hospital, I’ve had the opportunity to gain experience in different areas of the radiotherapy department. The Royal Marsden is at the forefront of innovations in the field and, since 2018, I’ve been lucky enough to specialise in one of our newer units, the MR Linac. This machine delivers radiotherapy with the guidance

“Having a direct impact on treatment delivery is really empowering” 18 RM magazine

of an MRI scanner, which allows us to tailor treatment precisely to the patient. We are one of only two NHS hospitals in the UK to have this specialist technology, which was funded by a £10-million grant from the Medical Research Council and supported by The Royal Marsden Cancer Charity. Treatment tasks Recently, I – along with the other therapeutic radiographers who work with the MR Linac – have taken on more responsibilities. The machine allows us to adapt treatment according to the patient’s anatomy

RADIOTHERAPY RESPONSIBILITY Helen’s role involes ensuring patients who are undergoing radiotherapy on the high-tech MR Linac are safe and comfortable, as well as making decisions about their treatment

A reassuring presence The MR Linac can feel like a small space and treatments take up to an hour, so making patients as calm and comfortable as possible is vital. I always explain what the treatment will involve so they know exactly what to expect. During the session, I keep in contact with the patient over the intercom and play music they’ve requested, which can be reassuring. We try to play whatever they ask for, from 60s classics and pop to rap and obscure genres of jazz – though one person just wanted to listen to the sounds of the MRI, which makes loud banging noises. The MR Linac is relatively new technology, so research is essential. At the moment, all our patients who have treatment on the machine do so as part of clinical trials. I love being involved in research as I feel like I’m making a difference – not just to patients now, but also to the next generation. It will be exciting to see the MR Linac become more widely available on the NHS, so that more people with cancer will be able to benefit from this highly accurate treatment. RM RM magazine 19

PAT H O L O G Y

PIONEERING DIGITAL PATHOLOGY Using sophisticated computing tools and artificial intelligence to uncover crucial clues about tumours, the new Integrated Pathology Unit is set to bring the discipline into the 21st century

THE FIELD OF pathology is one of the oldest in medicine and is vital in the treatment of cancer. Pathologists specialise in interpreting laboratory tests and evaluating cells, tissues and organs to diagnose disease. They determine the precise type and severity of the cancer and help to recommend a treatment strategy based on the test results. Advances in microscopy, imaging and DNA sequencing are uncovering more information about tumours than ever before. Now, a high-tech specialism called digital pathology could harness this raw data in exciting new ways, making it easier and faster to diagnose cancer. The new Integrated Pathology Unit at The Royal Marsden and The Institute of Cancer Research, London (ICR), is a pioneer in the burgeoning field of digital pathology, combining our expertise in clinical

DIGITAL EXPERTISE Professor Manuel Salto-Tellez

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“We’re one of the UK’s most advanced digital pathology units”

research with leading-edge tissue analysis to learn more about cancer. Digitising images Around the world, pathologists are starting to digitise pathology images and information so that researchers and clinicians can analyse them using computational tools. Sophisticated tumour imaging systems can scan slides of tissue samples taken from patients so that they can be shared with colleagues and assessed alongside molecular, radiology and pathology data. Once these slides are uploaded onto powerful computers, new levels of information can be found within them. Digital pathology aims to integrate data from these different sources using analytical tools that harness artificial intelligence (AI) to help spot patterns and crucial clues that would not be visible to the naked eye. Algorithms can accurately measure tumour boundaries and the levels of key cancer proteins from pathology data or predict the presence of mutations and genetic signatures. This presents the chance to make a huge difference to the

TEAM LEADER Professor Yinyin Yuan

way we understand, diagnose and characterise cancer, and gain new insights into the disease. Building expertise In the Integrated Pathology Unit, The Royal Marsden and the ICR are building their expertise in digital pathology under the leadership of Professor Manuel Salto-Tellez, who joined in 2020. Professor Salto-Tellez is an international leader in digital RM magazine 21

PAT H O L O G Y

IT HAPPENED TO ME

seen by doctors, which could help to detect cancer before symptoms occur or make earlier assessments of whether treatment is working. For example, Professor Yuan and colleagues have trained an AI tool to determine which patients with lung cancer have a higher risk of their disease coming back after treatment. “The tool can differentiate between immune cells and cancer cells,” she says. “This enables us to build a detailed picture of how lung cancers evolve in response to the immune system in individual patients. “Patients with fewer regions of immune-rich cells were at a higher risk of relapse, so the tool could predict which patients are more likely to see their lung cancer return, and who could be offered tailored treatment plans.” pathology. His team at the ICR is leading efforts with colleagues at The Royal Marsden to ensure that all our pathology images are captured digitally, which will be a hugely important initial step in enhancing cancer diagnosis and treatment. “Together, we will run one of the most advanced digital pathology units in the UK,” he says. “Digital imaging will allow doctors to measure tumour size more easily or look at multiple biological markers of cancer at the same time, while ensuring information can be accessed and analysed remotely. “And with digitisation, our researchers can drive forward the development of an array of new computational image-analysis tools, making use of AI to support

“Our AI tool could predict whether lung cancer might return” 22 RM magazine

pathologists in making key decisions about a cancer’s diagnosis.” AI and machine learning Computers are excellent at finding patterns in data, and using tools such as AI and machine learning, they can be taught how to identify features in digital pathology images that are linked with cancer. Professor Yinyin Yuan leads the Computational Pathology and Integrative Genomics Team at the ICR, which aims to train computers to automatically identify cancer cells in pathology samples from the clinic. Computers can mark areas with similar features in tumour samples to quickly identify cancer cells and other tissue types. These can be compared with other samples and assessments by pathologists to fine-tune the results, and to make new observations that couldn’t be made by human pathologists. Digital pathology images analysed by machine learning could spot patterns that can’t be

SCREEN TIME Pathologists at the ICR and The Royal Marsden are aided by powerful digital tools

Visualising cancer in new ways Professor Yuan, Professor SaltoTellez and their colleagues are building a range of tools to process and classify images of tumour tissue to help pathologists. By drawing on the rich information contained in these images – and combining it with other types of information such as DNA sequencing data from cancer cells – our researchers can visualise cancer and its surrounding tissues in new ways. Using the abundance of digital information produced when a person is scanned and tested for cancer, digital pathology could uncover extraordinary new information about the disease. This could help us understand how cancers interact with their environment as they develop and spread, diagnose patients more quickly or precisely, and predict how they might respond to treatment. The possibilities seem endless. RM

LEUKAEMIA WAS THE LAST THING WE EXPECTED, BUT OUR LITTLE BOY WAS IN THE BEST HANDS Carine Bryer, mum of leukaemia patient Reid, three

he needed. It would involve a lot of different medications – and, as a parent, you don’t want your child to be on too much or too little. We were referred to The Royal Marsden’s Oak Centre for Children and Young People to begin treatment, starting with 10 days of chemotherapy. From day one, we knew Reid was in the best place and in the best possible hands. Within a month, tests confirmed that the treatment was working and Reid was in remission, which was incredible news. To hear he was responding so well was everything we wanted. Reid completed the final phase of intensive treatment in September, and has now begun three years of maintenance therapy with frequent hospital visits and check-ups.

“It hasn’t been easy, but Reid’s now running about and getting stronger every day”

IN APRIL, my husband and I were taken into a small side room at a local hospital and told that our son Reid had leukaemia. We were in complete shock and disbelief. We knew something was seriously wrong, but leukaemia was the last thing we expected to hear. It was soon confirmed that Reid had acute lymphoblastic leukaemia (ALL), but we still

needed to understand which risk group he was in as this would determine what his treatment plan would be. The hospital sent for further tests to be done at The Royal Marsden, and it was quickly confirmed that Reid’s ALL had a good prognosis. We were relieved and hugely comforted to know that this result meant he would get the exact treatment

It hasn’t been easy for Reid. He couldn’t walk at all after the first month of treatment, so we carried him around everywhere. But he has built his strength back. Today, he’s running about and his little legs are getting stronger every day. In September, he went back to preschool and absolutely loves it. Reid is such a fun kid and it’s wonderful to see him back to his cheeky, charming self. He has been through such a lot, but he’s done brilliantly. We are so proud of our little boy. RM

Dr Elsje Van Rijswijk Consultant Paediatric Oncologist

“It is always a shock to be told your child has leukaemia. I was therefore very pleased when the fluorescence in situ hybridization (FISH) test results came back quickly, showing that Reid was in a good risk group with an excellent chance of cure. I was excited to be able to share this news with his parents to provide that all-important reassurance early on in his journey. “Reid suffered many side effects early on in his treatment, so it’s really lovely to see him becoming a lively, chatty little boy again. I feel privileged to be a part of his journey.”

RM magazine 23

HOLISTIC APPROACH

... A ND R EL A X Cancer can evoke a range of symptoms, emotions and side effects, so The Royal Marsden provides massage, aromatherapy and reflexology services as part of its holistic approach to treatment STEPHANIE WELLARD WAS diagnosed with triple-negative breast cancer during lockdown last year. Juggling home schooling, aggressive chemotherapy and the strain of living through a pandemic left her burnt out and anxious. “Things were really stressful, and I was experiencing so many side effects,” Stephanie, 38, recalls. “I was in pain and had a lot of fear because of the stigma attached to triple-negative breast cancer. “I couldn’t have anyone come with me for my hospital appointments due to COVID-19, so I was on my own all the time. I really wanted a massage as I knew how soothing they could be, but there was nowhere open or safe to have this treatment. I couldn’t believe it when I saw that it was available at The Royal Marsden!” Oils and aromas Our Complementary Therapy team provides massage, clinical aromatherapy and reflexology 24 RM magazine

services as part of an evidencebased, holistic approach to helping patients cope with symptoms and the side effects of treatment. Our therapists create special blends of essential oils to aid relaxation and address symptoms such as nausea, anxiety and insomnia. Patients can inhale these through personal nasal inhalers known as aromasticks or be massaged with oils on the affected parts of the body. The therapists visit inpatients at the bedside and in the Medical Day Units, adapting their treatments to preserve privacy and dignity – for patients who are immobile, for example, or sat in a busy room. They also see outpatients in a tranquil and comfortable treatment room. “One of the appeals of these treatments is that they are not medical,” explains Elaine Charlesworth, Complementary Therapy Lead. “When you are already taking so much medication on a daily basis, being able to do something to manage your symptoms without taking another pill is really important.” Another positive aspect is the autonomy it gives patients. “They don’t have much control over a lot of the other things that are happening to them,” Elaine explains. “The doctors will tell them what they need to do next. But they can accept or decline what we offer them.”

A SOOTHING SERVICE Elaine Charlesworth leads our Complementary Therapy team (above); essential oil blends help patients relax (right); therapist Ana Angarita provides massage therapy (left)

Treating the ‘intangibles’ Elaine’s team is in regular demand across both the Chelsea and Sutton hospitals. “We see all patients, from diagnosis right the way through to end of life,” she says. “We receive referrals from the pain, palliative care and psychological support teams and our colleagues in rehabilitation. We might be seeing someone who is anxious because they have just been diagnosed and

“It was such a peaceful experience – I really let go”

feel nervous about coming in for their first chemotherapy session. Or we could be visiting someone post-surgery on a ward. “We often treat the ‘intangibles’. Sometimes, the nurses will refer people, but they can’t pinpoint what they need help with. People who have cancer are going through a lot – and during the pandemic, without being able to have visitors accompany them in hospital, there is often heightened anxiety; this can have physical symptoms too.” Breast cancer patient Stephanie suffered with nerve damage after receiving the chemotherapy treatment paclitaxel, which gave her frequent pins and needles in her feet and legs. Her therapist made a special blend to help with these symptoms and gave a massage to ease muscular cramping. “After my first treatment, I nearly floated back to the car,” she says. “Aromatherapy massages are such a holistic and peaceful experience – I really let go. The service offered me a safe space to let out all the tension, which was just what I needed after such a horrendous time.”

Adapting the service The pandemic meant that the team had to change how they worked to continue the service. For a few months, they were unable to enter the wards or offer massages, so instead made special oil blends and posted them to patients at home. With clinical teams working round the clock during lockdown to maintain COVID-19 infection control and cope with the surge in patients, the aroma blends soon became popular among hospital staff too. “We created five blends that would be useful for their specific needs,” says Elaine. “For example, we made one blend to help with relaxation after a long shift, and another that would help energise them before and during one. “We made large batches and, in that short time, sent out more than a thousand aromasticks to staff across the hospital. They were really grateful.” RM

Want to know more? Call the Rehabilitation Secretary in Chelsea on 020 7808 2759 or in Sutton on 020 8661 3005 RM magazine 25

T H E R O YA L M A R S D E N C A N C E R C H A R I T Y

HIGH LIFE Supporter Steph during her skydive (left) and on the ground (below)

In the pink with Ralph Lauren

and mass participation events are live across the country, we’ll be making up for lost time. Antonia Dalmahoy, Managing Director of the Charity, said: “We’re so excited to be able to get together and recreate the fantastic atmosphere that The Banham Marsden March is famous for. It’s been a long wait and we’re looking forward to seeing all our fantastic supporters in person, reunited to support the work of the hospital. “I’d like to say a huge thank you to Banham, our incredible title sponsor, without whom the event would not be what it is.” There will, as usual, be a five-mile option and, after its success last year, a virtual alternative for those who can’t make the in-person event.

Pink Pony, Ralph Lauren’s global fundraising and cancer awareness initiative, celebrated its 21st year in October. We were delighted to be involved as part of The Royal Marsden Cancer Charity’s longstanding partnership with Ralph Lauren Corporation. This year, 100 per cent of the proceeds of each Pink Pony Fleece Hoodie and 25 per cent from all other items sold in the Pink Pony Collection in the UK went to the Charity, with shoppers also able to donate online and in stores. The money raised contributed to Ralph Lauren’s pledge to fund the Ralph Lauren Research Zone in the Oak Cancer Centre, The Royal Marden’s new treatment and research facility being built in Sutton. Deborah James, broadcaster, author and Royal Marsden patient, is a long-term supporter of the Pink Pony campaign, so Ralph Lauren also kindly donated to bowel cancer research at the Trust in recognition of her support.

Want to know more?

Visit royalmarsden.org/march for more information and to book your place

Visit ralphlauren.co.uk/ pinkpony

THE BANHAM MARSDEN MARCH IS BACK! WE’RE DELIGHTED TO announce the return of the in-person Banham Marsden March on 22 May 2022, when thousands of Royal Marsden Cancer Charity supporters will come together to walk 15 miles between The Royal Marsden’s Chelsea and Sutton hospitals. The Banham Marsden March is the Charity’s annual flagship fundraising event and raises more than £1.5 million every year. In May 2020, we were set to celebrate the walk’s 10th anniversary, but the pandemic meant that we launched a Banham Marsden March at Home event instead, with everyone walking closer to where they live. Now that social distancing restrictions have been lifted

“We’re so excited to be able to get together in person” 26 RM magazine

The sky’s the limit!

A trip of a lifetime Join Olympic medallist Iwan Thomas and a team of Royal Marsden Cancer Charity supporters on the Inca Trail Trek to Machu Picchu in Peru in September 2022. Iwan and his friends have signed up to help the Charity raise the final millions needed for the Oak Cancer Centre, which will transform the lives of cancer patients at The Royal Marsden and around the world – and you could join them. This trip of a lifetime follows an alternative route in the Lares Valley, taking in the hot springs at Baños del Inca, the Inca capital of Cusco, and the lost city of Machu Picchu at 2,430 metres above the Sacred Valley. Iwan (below) said: “I am all about pushing myself and setting myself new goals – and what better way than joining some amazing people raising money for The Royal Marsden Cancer Charity trekking the Inca Trail?”

Want to know more? IF YOU HAVE a head for heights or simply want to challenge yourself, the Oak Cancer Centre Parachute Jump could be for you. Taking place on 4 June 2022 at the Netheravon airfield near Salisbury, it’s a sponsored tandem skydive in which you’ll be strapped to a professional parachute instructor at all times. You’ll jump from a plane at 10,000 feet, freefall to 5,000 feet, then ride the parachute down

to the ground – all while raising money for The Royal Marsden Cancer Charity. Steph Cogan completed a similar jump in July for the Charity and highly recommends it. She said: “I was very nervous the night before, but the adrenaline kicks in and the cause gets you through the fear. “Knowing I’ve helped at least one family made all the fear go away, and you beam with pride at the end.”

Sign up at royalmarsden.org/ peru and enter the promotional code RM20 to get 20 per cent off the registration fee (until 31 March)

Want to know more? Sign up for your skydive by 1 April 2022 at royalmarsden.org/skydive

Contact The Royal Marsden Cancer Charity Telephone 020 7808 2233 Email charity@royalmarsden.org Visit royalmarsden.org Registered Charity No. 1095197 RM magazine 27

F O U N DAT I O N N E W S

ON THE BRAIN Professor Chris Jones

BREAKING THE BARRIER Artificial intelligence has helped researchers make major progress in treating an incurable childhood brain cancer SCIENTISTS AT The Institute of Cancer Research, London (ICR), and The Royal Marsden have used artificial intelligence-enhanced tools to successfully propose a new combination of drugs for use against diffuse intrinsic pontine glioma (DIPG), an incurable childhood brain cancer. The approach allowed our researchers to explore ideas on how to target DIPG in young patients who have mutations in the ACVR1 gene, which is about a quarter of children with this type of cancer. There is currently no treatment targeting this mutation approved for use in DIPG. 28 RM magazine

The targeted drug vandetanib, which is approved for treating thyroid cancer, acts against the ACVR1 gene. However, it has difficulty getting past the blood-brain barrier, so it cannot build up to a high enough concentration in the brain to have a therapeutic effect. But by using an artificial intelligence (AI) drug-discovery platform built by BenevolentAI, scientists found that a drug called everolimus could prevent vandetanib from being ejected from the brain, allowing it to treat the cancer. Study leader Professor Chris Jones, Professor of Paediatric Brain Tumour Biology at the ICR, said:

“DIPG is a rare and aggressive childhood brain cancer, and survival rates have not changed over the past 50 years, so we desperately need to find new treatments for this disease. “The AI system suggested using a combination of two existing drugs to treat some children with DIPG – one to target the ACVR1 mutation, and the other to sneak the first past the blood-brain barrier. The treatment extended survival when we tested it in a mouse model, and we have already started testing it out in a small number of children.” Dr Fernando Carceller, a Consultant Paediatric Oncologist at The Royal Marsden and Leader of the Paediatric & Adolescent Neuro-Oncology and Drug Development team at the ICR, said: “Close collaboration between scientists at the ICR and clinicians at The Royal Marsden made this bench-to-bedside approach possible. “The clinical results are too preliminary so as to draw firm conclusions, but we are working to take this combination forward in a clinical trial for children with ACVR1-mutant DIPG.” The research was published in the journal Cancer Discovery and was funded by Brain Research UK, the DIPG Collaborative, Children with Cancer UK, Abbie’s Army, Lucas’ Legacy, the Lyla Nsouli Foundation, Cancer Research UK, and a George and the Giant Pledge donation to The Royal Marsden Cancer Charity, with additional support from the NIHR Biomedical Research Centre at The Royal Marsden and the ICR. RM

What is the Biomedical Research Centre?

The National Institute for Health Research-funded Biomedical Research Centre for cancer is a partnership between The Royal Marsden and The Institute of Cancer Research, London. It supports the rapid translation of leading-edge cancer research from the laboratory and into a clinical setting. Find out more at cancerbrc.org

PANDEMIC RESPONSE IN FOCUS AT AGM

Dates for your diary Board of Directors meeting 8 December 2021, 9am-12pm Council of Governors meeting 13 December 2021, 11am-1pm Council of Governors meeting 16 March 2022, 11am-1pm Board of Directors meeting 30 March 2022, 9am-12pm

VACCINE LOGISTICS Dr Susanna Walker

THIS YEAR’S Annual General Meeting was held virtually due to the COVID-19 pandemic, with attendees watching online from their homes and offices. Chairman Charles Alexander, Chief Executive Dame Cally Palmer and Chief Financial Officer Marcus Thorman first updated attendees on the Annual Report and Accounts for 2020/21. Following this, Dr Pascale Gruber, Consultant Anaesthetist, and Natalie Percival, Divisional Nurse Director for Clinical Services, spoke about the work of the Critical

Care Unit (CCU) during the pandemic. They discussed the challenges faced by teams working through the COVID-19 waves, the lessons they learned and the new ways of working they implemented. They also talked about how the CCU supported the national COVID-19 response and the pivotal role it played in supporting the Cancer Surgical Hub, which allowed patients to access major cancer surgery during the pandemic. Dr Susanna Walker, Consultant Anaesthetist, then presented on

The AGM heard presentations about the CCU’s work during the pandemic and the Trust’s vaccine rollout

The Royal Marsden’s COVID-19 vaccine rollout. Dr Walker explained the logistics of vaccinating as many staff and patients across both hospital sites as possible without wasting the vaccine, and how we achieved a high staff vaccination rate of 89 per cent. She also spoke about the complexity of navigating changes to the Joint Committee on Vaccination and Immunisation’s advice and managing risk for our patients. Want to know more? Watch the AGM video and download the presentations at royalmarsden.nhs.uk/royalmarsden-annual-generalmeeting-2021

To attend any of these online meetings, email corporate. governance@ rmh.nhs.uk

Keep in touch Call 020 7808 2844 or email trust. foundation@rmh. nhs.uk. Contact your Governor by email at governors@ rmh.nhs.uk

Become a member To sign up and become a member, visit royalmarsden. nhs.uk/ membership or call 020 7808 2844 to request a membership form

RM magazine 29

PUZZLES & PRIZES

PRIZE CROSSWORD

Send your crossword with your name and contact details to RM, PR and Communications Team, The Royal Marsden, Fulham Road, Chelsea, London SW3 6JJ. The entry closing date is 24 January 2022. See below for prize draw rules. Autumn 2021 crossword solution Across 1 Amble 4 Blend 6 Vanilla 8 Moors 9 Saute 11 Tusks 13 Alley 14 Risotto 16 Clear 17 Endue Down 1 Altimeter 2 Baboons 3 Eaves 4 Bands 5 Eel 7 Acetylene 10 Unlaced 12 Sitar 13 Abode 15 Sue

11 12

13 14

16 z

WINTER 2021 PRIZE CROSSWORD ENTRY FORM Fill in your details below when sending in your crossword competition entry. See above for details of our address. NAME ADDRESS

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30 RM magazine

Try the fiendishly tricky numbers puzzle – it’s just for fun

FOR THE ROYAL MARSDEN

2 6 3 9 1

4 3 8 2 3 1

8 2 3 7 3 8 5 4

3 7

5 2 8 6 2

CROSSWORD CLUES

THE TEAM

Congratulations to Janine Terrieu, the winner of the autumn 2021 issue’s crossword prize. 1

SUDOKU 4

The lucky winner of our prize crossword will receive a £50 John Lewis & Partners gift card.

S TAY I N T O U C H

Across 1 Public transport (5) 4 Curved sword (5) 6 Western Asian country (7) 8 Used to catch fish (4) 9 Keen (5) 12 Poor and deprived (5) 13 A person from central or Eastern Europe (4) 15 State something in a solemn manner (7) 17 See 4dn 18 Places to deposit money (5)

Down 1 Vertebrate (9) 2 Coastal holiday place (7) 3 Car (4) 4 & 17ac Diarist (6,5) 5 Boy’s name (3) 7 Burrowing mammals (9) 10 Old, sailed ship (7) 11 Road (6) 14 Edge of pavement (4) 16 Hat (3)

Rachael Reeve Director of Marketing and Communications Abby Samuel Head of PR and Communications Morwenna Darby-Gould Senior PR and Communications Manager Catherine O’Mara Senior PR and Communications Officer Francesca Vitale Senior PR and Communications Officer Georgia Tilley Senior PR and Communications Officer Emma Dowse Senior Case Studies Officer Orla Anandarajah PR and Communications Assistant

FOR SUNDAY Marc Grainger Editor Robert Hearn Senior Designer Nina Whitley-Jones Designer Emma Franklin Group Account Director Richard Robinson Content Director Sam Walker Creative Director Toby Smeeton Managing Director

PRIZE DRAW TERMS AND CONDITIONS

RM magazine is published by The Royal Marsden in partnership with Sunday: wearesunday.com

1. The Prize Draw is open to all readers of RM except employees of the Press Office at The Royal Marsden and Sunday, who produce RM magazine. 2. The closing date for receipt of all entries is 24 January 2022. Only one entry per person per draw. 3. Responsibility cannot be accepted for entries that are incomplete, illegible or not received. Proof of posting is not proof of receipt. No cash alternative is available and prizes are not transferable. Value of prize is correct at time of going to press. 4. Winners will be notified by post within 14 days of closing date.

© The Royal Marsden 2021. All rights reserved. Reproduction in whole or part is prohibited without prior permission of the Editor. The Royal Marsden and Sunday accept no responsibility for the views expressed by contributors to the magazine. Repro by F1 Colour. Printed by Geoff Neal Group.

5. The Promoter’s decision on any aspect of the promotions is final and binding. No correspondence will be entered into. 6. The Promoter reserves the right to substitute a prize of equal or greater value should circumstances make this necessary. 7. Entry implies acceptance of rules. 8. The winner of the crossword prize of a £50 John Lewis & Partners gift card will be the first correct entry drawn out of the bag. 9. The Promoter is The Royal Marsden, Fulham Road, London SW3 6JJ.

COMMENT, LIKE, SHARE Join the conversation on Twitter @royalmarsden and @royalmarsdenNHS Facebook @royalmarsden, @royalmarsdenchelsea and @royalmarsdensutton Instagram @royalmarsden Facebook

Instagram Emma @limitless_em Love you @bowelbabe Thank you @royalmarsden for sitting us next to each other in the Chemo ward this afternoon. It was a beautifully playful, uplifting, spirit boosting one. One to treasure. We definitely followed the sun today [right]

Sarah J Newman Thank you Dr Carceller, making sure my Ben got the best possible treatment [right]. Gill Gillj Love the work you all do the Royal Marsden kept my dad alive 15 years from diagnosis Amy Hunt Incredible!! Such wonderful news! My partner was diagnosed stage 4 with poor prognosis, Royal Marsden gave him the Tiger trial!! He’s now 2 years in Remission! Forever thankful to this Incredible hospital xx

Twitter Mark Smith @epworthsmithy We all moan and grumble in our working lives from time to time but having spent time with the Portering teams at the famous Royal Marsden cancer hospitals in Chelsea and Sutton over the past two days... you are an inspiration to me!!

Mark @sparkiemah I would like to thank Mr Asif Chaudry for choosing me to be the 1st patient to have my type of surgery with the Da Vinci Robot & The Royal Marsden for their progressive treatments to help fight this life shattering disease... I will be eternally grateful for their amazing knowledge, professionalism & hard work

getting me the result of 5 yrs cancer free! Tracy @tracyjh64 Mr Asif Chaudry, Dr David Watkins & their teams gave Mark excellent care... We can’t thank the Royal Marsden enough... they have been amazing & so supportive from start to finish.

020 7352 8171

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VISIT US ONLINE royalmarsden.nhs.uk WANT TO WORK AT THE ROYAL MARSDEN? Visit jobs.royalmarsden.nhs.uk READ RM MAGAZINE ONLINE royalmarsden.nhs.uk/ rm-magazine

CONTACT THE ROYAL MARSDEN HELP CENTRE For confidential chat, support and information, call

STAY IN TOUCH WITH THE ROYAL MARSDEN CANCER CHARITY

CONTACT THE FRIENDS OF THE ROYAL MARSDEN, CHELSEA

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CALL US

or visit royalmarsden.nhs.uk/ your-care/royal-marsdenhelp-centre

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For general feedback, compliments, concerns or complaints, send us a message royalmarsden.nhs.uk/ contact-us/get-in-touch

VISIT US ONLINE royalmarsden.org Registered Charity No. 1095197

020 7352 3875

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Look out for the spring 2022 issue of RM – coming March 2022 RM magazine 31

Write your Will for free Give back to the future

Writing or updating your Will can feel like a big decision, which is why The Royal Marsden Cancer Charity has a simple and free service that can help you. We hope that once you have included your loved ones, you’ll be inspired to leave us a gift in your Will – although there is no obligation to do so. Your gift can help fund our life-saving research that will make a vital difference to cancer patients long into the future.

To sign up visit royalmarsden.org/freewill or call 020 7808 2233 Registered Charity No. 1095197