In an editorial published today in ecancermedicalscience, leading academics from across the UK outlined the risks facing cancer care, treatment and research in a post-Brexit world.

The editorial, authored by 6 doctors representing cancer physicians, patient advocacy groups and genomics research, calls for Brexit negotiations to include plans for the UK’s relationship with EU partners in terms of funding research, attracting top international talent to UK institutions, working together as partners and handling the regulatory issues of ongoing collaborations in cross-continental projects.

“It is important that the UK’s cancer researchers and cancer care providers watch the “Brexit space” very closely” the authors write. “We need to take every opportunity to remind the UK government that cancer patients and cancer research could be significantly disadvantaged, unless great care is deployed in the negotiations of the legal and economic frameworks which will govern the UK’s relationship with the EU beyond Brexit.”

Two of the editorial’s lead authors, Professor Peter Selby, Professor of Cancer Medicine, University of Leeds, President, Association of Cancer Physicians (UK) and European Cancer Concord, and Professor Mark Lawler, Chair of Translational Cancer Genomics, Centre for Cancer Research and Cell Biology, Queens University Belfast and Vice President for Research and Innovation, European Cancer Concord, describe their uncertainty for future British cancer research outside of EU funding and projects, but note that nothing is yet certain.

Professor Lawler stated: “It is vital that UK researchers continue to perform high quality science that leads to new diagnostic tests and therapies for cancer patients. Research is no longer an ivory tower silo-type pursuit – collaboration is the key. UK scientists contribute greatly to the European research effort while having scientists from different countries working within our research institutions and hospitals contributes greatly to our battle against cancer.” 

“The United Kingdom voted by a small margin to leave the European Union (EU)” they note. “The consequences of that vote are as yet far from clear. Nothing has changed at the moment and nothing will change until the UK’s intention to withdraw from the EU is stated officially and there is a two year period within which the terms will be settled by negotiation.  Clearly, at the time of any exit, there will have to be in place a legal framework to replace that which has been provided through the EU.”

Last May, the group behind this new editorial wrote a Perspective published in The Lancet Oncology in which they made the case for voting Remain.

At the time, they wrote “We must continue to influence and share European policy in important domains such as clinical trials, data sharing, and clinical best practice, and deliver the highest quality cancer research that underpins improved cancer care for our patients. It is for these reasons that we oppose the UK leaving the EU.”

In the aftermath of the June referendum, the group is calling for consideration of the regulatory and organizational issues facing cancer research and patient care.

“We expressed lack of confidence that if current regulatory structures were lost as a result of leaving the EU they may not be replaced by UK government.  The jury remains firmly `out’ as to the consequences of an EU exit for cancer research and cancer care, but there are widely held concerns among the cancer community.

Brexit would mean that the EU Directive no longer applied in the UK, which is of concern to the manufacturers of devices and tests unless the EU and the UK share regulatory frameworks in future to allow ready import and export of devices/tests.”

Further complicating matters is the headquartering of the European Medicines Agency (EMA) in London.

Professor Lawler continued “It is also possible that the EMA would not feel it was appropriate to have its headquarters in a country not fully part of the EU.  If the EMA was to move to another jurisdiction, then the Medicines and Healthcare products Regulatory Agency (MHRA) would have to step up to take over certain regulatory activities and conduct cooperations with other global regulators.”

"Additionally, the uncertainty about research funding may discourage senior researchers from relocating to the UK, particularly if they felt that prestigious funding like European Research Council grants and Horizon 2020 were no longer available to them. Anecdotally, a number of UK institutions have already indicated that pre-Brexit recruits have turned down positions due to uncertainties in related to continued EU funding.”

A key issue facing cancer researchers and patients today is how sensitive patient data is handled.

Genetic analysis of tumour samples can help decide what course of treatment is best for individual patients, and help researchers fully understand the mutations behind many cancers.

One recently announced international project, HARMONY, seeks to centralise and make better use of genetic data from blood cancer patients across Europe.

“There would be considerable uncertainty about the movement of personal research data between the EU and the UK.  Data protection regulations would influence UK companies wishing to trade in services to individuals within the EU.  All of this is likely to be the subject of complex negotiations.

We need to break down data silos not build them up. It is vital for cancer research and most importantly for our patients that we share information that can help to identify new targets for cancer therapy” said Prof Lawler.

“After Brexit, the UK will have to establish its own clinical trials regulatory environment which will require careful design to achieve the minimum necessary bureaucracy and compatibility with other European countries for multi-national trials.” the group adds.

The authors do note that some consideration for the role of UK research, especially in bioscience, has been part of planning so far, but that the future is far from certain.

“Some reassurance has been offered.  It has been agreed that current EU grant funding held by UK individuals and institutions will be honoured.  In addition, the UK government is talking about increasing the total spend available for research, within which cancer might figure significantly.”

“But will they continue to fund researchers who compete successfully for European grants – that is the key question that needs to be answered” said Prof Lawler.

“When the Brexit negotiations are complete, UK government may be prepared to step up to efficiently fill the gaps in law, regulation, resource allocation and strategic alliances that will probably ensue. If they do not do so, cancer research and cancer patients will suffer” the authors conclude.

“Remember we must put the patient first” added Prof Lawler.

Source: ecancermedicalscience

Reference: Selby P, Lawler M, Baird R, Banks I, Johnston P and Nurse P (2017) The potential consequences for cancer care and cancer research of Brexit ecancer 11 ed63 DOI: 10.3332/ecancer.2017.ed63