Clinical FeaturesOncology

Ask the Expert – Professor Seamus O’Reilly

Prof Seamus O’Reilly BSc MD PhD FRCPI is Consultant Medical Oncologist at Cork-Mercy and South Infirmary Victoria University Hospitals, Clinical Lead at Cancer Trials Ireland, and Clinical Professor at University College Cork. A graduate of University College Galway (BSc, MB BCh BAO, MD) he completed basic specialist training at Trinity College Dublin affiliated hospitals and medical oncology training at John Hopkins Hospital, Baltimore, MD where he was subsequently Assistant Professor in Medical Oncology. During fellowship training there he completed a PhD in Clinical Investigation and focused on Cancer Pharmacology in his research. He is a founding trustee of the South Eastern Cancer Foundation and Cork ARC Cancer Support House and was National Specialty Director in Medical Oncology at the Royal College of Physicians in Ireland from 2013-2021 mentoring projects on litigation in breast cancer, climate change, rare tumor management, survivorship, pharmaco-economics, dental oncology, cyber security and the impacts of the COVID-19 pandemic on healthcare staff and patients.

At Cancer Trials Ireland he founded the National Green Cancer Clinical Trials Initiative in 2022, and is a member of the Executive Board of the Breast International Group (2021-5), The National Research Ethics Committee, Advisory Board of the National Cancer Registry, Irish Health Research Forum Steering Group, the steering committee of the All Ireland Cancer Research Institute, and The European Society of Medical Oncology Climate Change Taskforce, and Oncology Pro Group. He is deputy editor of British Journal of Cancer Reports. His main research focus are clinical trials in breast cancer, sustainability in healthcare, and survivorship.

We recently spoke with him to learn more about the work of this vital organisation, and to hear about his recent talk at the European Society for Medical Oncology (ESMO) Congress at the end of last year.

Cancer Care and Cancer Research

Giving us a brief overview of his career path to date, Professor O’Reilly told Hospital Professional News, “ I have been involved in clinical trials since my training days, having established a clinical trials unit in Waterford and a clinical trials unit in Cork. Thus, the length of time I have been completing cancer research is the same as my cancer care work.

“We are very committed to cancer care in Cork; our unit had its 20th anniversary last year and over 3,900 patients have been enrolled in cancer clinical trials in our unit. It allows patients access to the latest available treatments, creates an environment of inquiry, of standards in a unit and it also accelerates innovation in a unit as we are bringing in newer treatments, and newer platform agents, years before they would come into place if we waited until they are approved by the regulatory bodies and then reimbursed by the government.

“This allows people to access care at an earlier stage. Where clinical trials are embedded into cancer care, the outcomes for patients are better, and that’s a hugely important thing.”

Professor O’Reilly notes that currently, oncology is at an ‘exciting stage’ within Ireland, with many new agents in the pipeline.

He continues, “There is a drug class called anti-body drug conjugates and there are 160 of these in development globally at present. It is unclear which one of them is going to be the next transformative treatment. But it offers hope for patients where the standard treatment isn’t as good as it could be, or patients have side effects from treatment or the treatment simply does not exist. So creating an environment in our hospitals where patients have access to this innovation is of great significance.

“With Cancer Trials Ireland we have four main themes – for the next four years. The first one is streamlining. In order for patients to get access to these newer treatments, we need to be efficient in what we do and how we do things. We are competing with other countries. For instance, in Latin America, there are 22 cities with populations of over a million people. So if a company tries to set up a trial there, they have huge access to a very diverse patient grouping to establish infrastructure. When we are being looked at as an environment to do trials, we need to be aware of the companies of choice, and the investigators of choice, in regards to where the drugs are.

“Streamlining our trials in terms of getting the regulator aspects and processes quicker is really important.”

The government has recognized and established a National Research Ethics Committee. And Professor O’Reilly sits on one of the committees of that. He explains that this is where clinical trials are reviewed.

“Historically,” he adds, “they were reviewed by various ethics committees around the country. But now there’s one major ethics committee. That allows economies of scale and expertise and also transparency in terms of efficiency. It is an incredibly well run organisation but there are also issues such as data protection that are involved in a clinical trial activation and there are insurance issues etc.

“Much like other enterprises, you’re only as good as your weakest link and you’re only as fast as your slowest part. A major aspect of my role is to look at how we can get these things done more quickly by getting involved, looking at the stakeholders involved, and engaging with all of them.

“The second aspect is getting more studies into Ireland. The 160 drugs that we talked about and getting patients access to those studies is a key thing for many people in our organisation and for other investigators in our organisation. There are international meetings taking place all the time; we go to those meetings and interact with the companies that are making these drugs and with the international co-operative groups that are involved in the trials, to highlight Ireland’s infrastructure and development, the intellectual capital that is here, and the patients here that would benefit from it.

“The third thing is succession. In any organisation we need to nurture the next generation. We have more oncologists now in Cork and we’re interviewing for our 11th consultant post. In 2005, we were down to one consultant at one stage so those developments are needed as cancer medicine is increasing. The information that we see is accelerating, so if you take all of the information that was developed since the start of civilization to the thousand, that same amount of information is created every year now.

“Medical knowledge doubles every 75 days and when I started as a Medical Oncologist, my first consultant post was in 1995 and then you could do everything. But now, to stay up to date in one disease area, you need to read 7 papers a day, 365 days a year.

“That just goes to show how things have evolved and so we look at succession planning we look at ways of nurturing the next generations so they can you know be involved in clinical trials.”

Competing Needs

Professor O’Reilly acknowledges that there are competing needs as the majority of healthcare workers are women.

“Often, the time when women start a new career is also when they are starting to raise families. We need to create a structure that allows women to participate in this, in addition to their job and we need to build an environment to make it easy for them to engage. If you look at the Irish healthcare landscape, and the people doing clinical research, the majority of research staff in clinical trials in Ireland are nurses.

“Building an infrastructure where we can encourage, recruit, and retain nurses and data managers in our system is also hugely important. It is not just about doctors and who will lead to studies. If you don’t have a team, you can’t build around it. So building an environment where people will want to come and get involved and stay in clinical trials is hugely important.

“The final theme is sustainability. If we look at the carbon footprint of clinical trials, it is half the carbon footprint of Denmark which is a country of 5 million people. Healthcare is very climateunfriendly. If you take for instance the carbon footprint of health care in the United States, it is the same as the entire nation of the United Kingdom. The carbon footprint of the NHS, the UK health system, is the same as the nation of Croatia.

“If someone has a robotic hysterectomy today in Cork, the carbon footprint of that is someone driving in a car from Madrid to Moscow. If someone has a tosalectomy in Cork and that generates 15 kilograms of waste, to incinerate that is 5,000 litres of water as the carbon footprint of nine families for a day. That’s just one operation.

“Climate change is very bad for cancer it disrupts cancer care. Fossil fuel pollution contributes to cancer, in France, they calculated that 3% of their breast cancer cases are due to fossil fuel pollution from cars. To put that in context, 7% of breast cancer in Ireland is due to alcohol. It’s a problem that’s getting worse. We’re all affected by it, 40% of our citizens were affected by global warming last year either through flooding or extreme weather events. We want to build sustainability into clinical trials and also awareness of it.

“Last year in 2022 we set up the national green cancer clinical trials initiative and we’ve established a green charter for cancer trials in Ireland. As the clinical lead, the board of charged me to integrate a green charter into what we do. That ranges from if we have a meeting, we look at what type of sandwiches we order. A vegetarian sandwich’s carbon footprint is half of a carnivore sandwich. It also extends into things like pensions and financial planning. In a study of hospitals in Boston, where they monitor energy consumption and they also declare how much money they have. What they found was that the carbon footprint of their financial Investments was three times greater than the carbon footprint of the energy used by the hospitals.

“Our group published a paper last year called ‘Climate Toxicity’ which is the impact of climate change on cancer care and the impact of cancer on climate change. It’s the first time the term has been used in medical literature. Our ambition is to look at other groups and green clinical trial groups globally and to integrate with them, work, and collaborate with them to be a sustainable clinical trial group.”

Professor O’Reilly states that it is imperative the medical profession speak up.

“The decisions that need to be made about healthcare, about climate change, are political in addition to individual. But if the medical community is silent about this, it’s very hard for the politicians to be vocal.

“We need to speak up. Both in terms of the impact of climate change on our patients, in terms of cancer care but also in terms of being more active and more responsible in healthcare. I think that sometimes people feel that healthcare is so important, that the same standard shouldn’t apply to it as everything else. But I think that’s a missed opportunity, especially since it contributes so much.”

Climate Toxicity

It was this paper which led to Professor O’Reilly and his team being invited to present at the 2023 European Society of Medical Oncology Congress.

He tells us, “My talk was mainly about the impact of climate change on cancer care and it ended with what we should do next, which is probably the important part. We looked at the ways in which we can make our healthcare more sustainable. I worked with Catherine Wedik, the co-author of the climate toxicity paper to put the talk together.

“It’s a living document that pulls from various sources around in the literature as regards to how we can make an organization more carbon-friendly. The other aspect we talked about was work within clinical trials and we assessed the carbon footprint of a clinical trial. That was carried out in conjunction with the group in the Institute of Cancer Research in the United Kingdom.

“I am also a member of the Executive Board of the Breast International Group and I spoke at their meetings last year. We’ve developed a survey of breast cancer trials organisations globally. The Breast International Group covers 50 members from five continents and the survey targeted them to see what their experience with climate change was, and what would it take to develop a green clinical trial initiative, so to speak. That survey was completed around Christmas and we are analysing it with the ambition to see what that shows and note the level of interest in this and what the barriers would be to implementing it.

“But the countries that are represented in it, Spain, France, Greece, Canada, and Australia, just to name a few, have all been affected by climate change. There’s been a good level of enthusiasm, support, and interest, particularly by the leadership of the Breast International group about the initiatives. Using the energy of so many groups being involved, to bring about initiatives that would make our clinical trials Arena more climate responsive, is the ambition.

“Whilst we are talking about climate toxicity, there is also a phrase known as climate therapy. This presents the topic in a more positive way. I think a lot of people are very scared about climate change because they feel that they’re very vulnerable to it, particularly younger people. They also feel that the people of influence and power are higher up than them and are going to be least affected by it.

“Climate change here really started in the 1950s and 1960s and while we are the group that got the most from fossil fuels, we are also the group that’s not going to be affected that’s very frustrating for the younger generation.”

Tree of Solutions

There was great interest and further discussion on the back of Professor O’Reilly’s talk but he is quick to add that ‘sometimes there’s inspiration and perspiration.’

He explains, “The inspiration part is the paper on climate change but the perspiration part starts now in terms of implementing and doing things. Of course, it’s going to be slow to begin with but there is a lot of interest in it.

“I have highlighted that the average medical student gets maybe two hours of information about climate change during their medical training, for something that’s going to be hugely important in their lifetime. But I think also if we could also embed the awareness of climate change in terms of disposable objects, disposable items, in terms of how we practice, and being less wasteful in terms of what we do. That will be the biggest thing.

“Our aim at the moment is to look at certain disease types and develop a ‘Tree of Solutions’. The ‘Tree of Solutions’ in oncology will look at guidance to reduce unnecessary testing and guidelines, in terms of how we prescribe chemotherapy, such as how we could maybe use more oral tablets than IV because they have less of a carbon footprint. There’s plastic associated with it. Plastics need petrochemicals to generate, to make plastics you need petrochemicals. Those kinds of practical things that people could think of but that would become embedded in what they do. That is the ambition.

“I probably spoke about climate change maybe five or six times last year and what people are really taken aback by, is the impact of healthcare on climate change and how damaging our practice is to climate change.

The second aspect is how enthusiastic the younger generation is and how engaged they are. I think that’s very reassuring and I think we all need to be involved here. We all have a stake here.

“Clinical trial units were established owing to the Belfast agreement. Professor Paddy Johnson, who is Professor of Cancer Medicine in Belfast, looked at the Belfast agreement and integrated an All-Ireland National Council initiative. It is one of the best three outputs of the Good Friday Agreement.

“The National Cancer Institute got involved with the government and clinical trial units. So the clinical trial units we see around the country today are a direct result of the Good Friday Agreement. After that, it accelerated things. When we set up units in Waterford, we had to set up an ethics committee, we had to set up clinical trials, and we had to set up fundraising in the community to fund a research nurse.

“But when I moved to Cork, after the Good Friday Agreement was signed, the government got involved in setting up these clinical trials with a grand funding mechanism and the grant was due in 2001. A building was built, nurses were hired, and you didn’t have to go out into the community to fundraise to get to each stage. It accelerated us and

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