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Chai Cancer Care Together Magazine 2016 Dr Christopher McNamara is a consultant haematologist in the lymphoma service at University College London Hospital. He completed post-graduate training in Australia and France before appointment as consultant haematologist at the Royal Free, London in 2004. He moved to UCLH in 2015. His interests are clinical trials, radioimmunotherapy and the interface between the laboratory and lymphoma patients. He has served on several guideline development groups for the European Society of Medical Oncology, the British Council for Standardisation in Haematology and for the national Institute for Clinical Health and Excellence, where he served as clinical lead for the national lymphoma guideline. Lymphoma therapy update We know more than ever about how cancer of the blood behaves and which treatments will produce the best outcomes. Consultant haematologist Christopher McNamara looks ahead to future developments Lymphoma is the most common type of blood cancer affecting people in the UK. There are many different types of lymphoma but they all generally occur when a certain type of blood cell no longer obeys the normal control signals that govern the growth of cells and tissues of the body. The diseased cells or lymphocytes aggregate together and typically spread through vessels connecting lymph nodes. A significant amount of research work has been done to understand the differences between the different types of lymphoma. This work, culminating in a classification system adopted by the World Health Organisation, has made important advances in the way in which lymphoma research is carried out and in the way in which people who suffer from lymphoma are treated. Increasingly, lymphomas are categorised according to molecular and genetic changes within the abnormal lymphoma cells. These genetic changes influence the way in which the cancer cells multiply and often how they will respond to treatment. Understanding these genetic changes has already led to significant improvements in the treatments available for lymphoma patients and is likely to radically reform further these approaches in the future. “Understanding genetic changes has already led to significant improvements in the treatments available” GENES HOLD THE KEY Many people are surprised when they hear that the laboratory is the first and perhaps most important step in the journey that a lymphoma patient will begin. The reason for that is that an accurate diagnosis is critical for obtaining the best outcome for a patient; the treatments used, as mentioned, frequently differ according to which lymphoma subtype a person has. It is, therefore, essential that material from a biopsy be looked at by an expert pathology doctor. In the future it is likely that genetic changes within the first biopsy sample will be used for all patients to direct which treatment should be given, even within the same lymphoma subtype. In other words, patients with the same lymphoma subtype will be treated differently, according to the molecular changes in their lymphoma. CHEMO AND CHEMO-FREE THERAPY Importantly, the outcome for lymphoma patients has been improving in recent times. Twenty years ago there was concern that, in spite of the availability of effective treatments, the overall survival for lymphoma patients was not improving. That has now changed. With effective combinations and information gleaned from properly conducted clinical trials, effective therapies that are given to people with lymphoma today have shown unequivocally that outcomes have improved compared with treatments used as recently 20 years ago. There is a range of different treatments available to patients in the UK. Chemotherapy remains an effective and generally well-tolerated treatment for most people. However, it is also fair to say that there is increasing interest in ‘chemotherapy-free’ based approaches to managing lymphoma. Frequently, people affected by lymphoma have other medical problems, which preclude intensive treatment or they’re present at a point in their lymphoma journey where they are significantly debilitated and de-conditioned by the lymphoma itself. This makes the administration of chemotherapy sometimes difficult. In addition, we know from longitudinal studies that many patients who complete chemotherapy are affected by long-term physical, psychological and emotional problems that are most likely due to their chemotherapy. “Treatments by mouth generally don’t require admission to hospital and are very well tolerated” Many centres around the world are interested in this ‘chemotherapy-free’ strategy whereby new drugs other than chemotherapy are used to induce a response. A new immunotherapy involving antibodies directed at special markers on the surface of cancer cells called antigens is already in clinical practice and thousands of patients have benefited from this and lives have certainly been saved as a consequence. The clinic has also seen the development of new medicines, which inhibit signalling inside cancer cells. These medications have changed the landscape in some lymphoma subtypes and are likely to have a significant impact upon lymphoma therapy in the future. These treatments can be taken by mouth, generally don’t require admission to hospital and are very well tolerated. They work by penetrating the lymphoma cell and turning off the machinery that the cell needs to survive and prosper. One of the advantages of these medications is that they typically don’t bring with them many of the chemotherapy-related side effects. Nausea, vomiting and hair loss are not common from these drugs and they often produce very good results, even in patients who have previously failed to respond to chemotherapy. It is important that ongoing research is carried out to define the longer-term safety and effectiveness of these agents, but preliminary studies are very exciting. There remains a strong desire to continue to improve the outlook for people and families not only affected by lymphoma but also to try and reduce the short- and long-term side effects of therapy. Clinical trials that are currently underway are likely to contribute to the answer to this question. ■ The next leap forward: refining treatments • Molecular differences in their lymphoma subtype will mean patients with the same type of cancer will receive different treatments • Oral treatments will become more common • Advances in treatments will mean patients won’t need to be hospitalised 24 Together 2016 Chai Cancer Care 25
Chai Cancer Care Together Magazine 2016 Believing in better The potential to transform lives is a defining factor in the causes that attract Andrew and Orly Wolfson. It’s why Chai’s innovative approach to cancer support means so much to them One of the joys Andrew Wolfson has discovered in his 40s, is the breadth of Jewish festivals. ‘I was very much a Rosh Hashanah/Yom Kippur Jew,’ he says. Born into one of this country’s most philanthropic dynasties, the Wolfson family’s bequests benefit countless British, Jewish and Israeli causes and institutions. His very orthodox great-grandfather was Solomon Wolfson, a cabinet-maker who grew up in the Gorbals in Glasgow; his great uncle Isaac re-shaped retail as head of Great Universal Stores. His father, David was Next’s chairman during the 90s (a role now held by his brother Simon) and both are Tory peers. Andrew ‘probably didn’t do what was expected’ and his career took him not into big retail but niche investment. As MD of Pembroke VCT, his portfolio of brands include restaurants Five Guys and Chucs, fashion designers Bella Freud and ME+EM, and digital media businesses Boat International and Rated People. A largely secular upbringing took him to Radley College boarding school during term time, and to the country at weekends. Now, through his children, Lily 8 and Charles 7, who attend a Jewish primary school, he and his Dutch-born wife Orly, 39, delight in being a part of Jewish community life that neither was exposed to as a child. ‘We get Simchat Torah and Shavuot – which I didn’t know about as a child,’ says Andrew, 47. ‘Moving from Hyde Park to Belsize Park and then Finchley has changed our philosophy of community.’ Adds Orly, whose father converted to marry her Israeli mother, ‘We weren’t very involved in Jewish traditions when I was a child, and I wanted our children to have a greater sense of belonging. We’re learning and celebrating with them and it’s lovely.’ POSITIVE IMPACT The potential for transformation is lost on neither. Orly is a trustee of Beit Halochem UK and has chaired their annual fundraising dinner for the last three years. Beit Halochem have rehabilitation centres across Israel which provide support for 51,000 disabled soldiers and victims of terror. Her mother went through several years of rehabilitation after an accident, so it’s work that’s close to her heart. ‘A 20-year-old soldier wakes up in a totally new body and has to re-learn everything from step one. Beit Halochem helps that person become a member of society again, focusing on what they can do, not what they can’t. Much like Chai, it’s about not being left on your own.’ RayaCottrell Photography Orly admits she was nervous about her first visit to Chai’s flagship centre. ‘When you hear the word cancer, you feel a bit of a chill; the older you get, the more stories you hear. We all know someone who’s been through it. I won’t forget the day Louise took us around. It showed Andrew and I that the journey can be made easier. It’s such a positive, uplifting place. People want to hide their fears from their children, parents and partners. Here, you can share them and become part of the Chai family of support. The people involved are so passionate and inspirational.’ “The couple are drawn to projects that redefine or disrupt what is currently out there” Meanwhile, Andrew is the founder of MiSST (Music in Secondary Schools Trust), which grants funds to schools Andrew and Orly Wolfson with children Charles and Lily in challenging areas, to buy classical instruments and provide instruction so that whole year groups can participate in compulsory classical music. This September there will be 3,500 young people in the programme. ‘In schools with 60+ first spoken languages, music breaks down the barriers of ethnicity, age, religion and socio-economic group like no other subject.’ Since 2013, the scheme has seen one student go to Oxford to study music, and another join the National Youth Orchestra. Andrew blanches, however, at the memory of his own squandered musical education. ‘I was so lucky. My parents paid for lessons at primary school and they don’t know this, but I used to tell my English teacher that I had a music lesson, I’d tell the music teacher that I wasn’t feeling well and I’d go off and play cards in the loo.’ For sweets, he adds. Betting on the conventional certainly isn’t Andrew’s style. He spent one day at Exeter University before deciding ‘it wasn’t really my scene.’ He proposed to Orly just ten days after meeting her. For seven of those days they were apart, as Orly’s modelling career meant non-stop travel for brands such as Escada, Gottex and Wolford. Andrew flew to Israel where she was based, for the second date. ‘It was so exciting, I knew the rest of my life was going to change.’ Ten years on, ‘It’s the best decision I ever made.’ For her part, Orly was taken with Andrew’s ‘gentlemanly manners and his humour. He reminded me of Colin Firth, but a better version!’ Their contemporaryclassic, art-filled home is on an elegant North-west London street, where they enjoy as much family time as possible – especially playing sport with the children. They are expecting their third child imminently. ‘It is very powerful discovering for yourself what a difference a charity makes. That’s what happened to us with Chai’ Both as an entrepreneur and as a trustee of the Charles Wolfson Charitable Trust, Andrew is captivated by projects that ‘do things that redefine or disrupt what is currently out there and try and create a new normal’. It’s why he is drawn to Chai. ‘In its holistic approach, it gives an extra level of support on those days when you’re not in hospital having chemotherapy, but feel rotten. Not only that, it sustains all those around the cancer patient. There’s the security, too, of knowing that Chai understands Jewish traditions and values. It’s a fantastic – and vital – service. It’s acknowledged outside the community that we go the extra mile to care for our vulnerable.’ THE YOUNG VOTE With his passion for creating opportunities for the next generation (he is also involved in Access Aspiration, a work placement charity, and PaJes), he believes businesses and charities need to gain the confidence of the young to win their support. ‘Both have a responsibility to be transparent, charities especially with their fundraising and administration costs.’ He advocates organisations working together strategically for the longterm good of the community and sees Chai’s expansion in an existing Jewish community building in Manchester as a good example of this. ‘The home is also an important base for learning about caring for the needy,’ says Orly. ‘Our mum always taught the six of us, if you can help someone, why don’t you? If ever a neighbour had a problem, she was right there. You build on that with education. Hopefully our children see the amount of work that Andrew does, and the charities I’m involved with.’ She adds, ‘It is very powerful discovering for yourself what a difference a charity makes. Visit the charity. Meet the people who work there and the ones who are looked after. Understand the potential for your donation – and then you’ll feel a much stronger connection than simply attending an annual dinner. That’s what happened to us with Chai.’ ■ 26 Chai Cancer Care Together 2016 Chai Cancer Care 27
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Page 25 and 26: Service Spotlight Manual lymphatic
Page 27 and 28: CHAI CHALLENGES YOU! MAY GLASGOW GI
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