Dr Becki Lee is a clinician scientist who left the lab to return to her work as as a cancer doctor in Manchester.
From labs closing to funding cuts, the impact of COVID-19 on research has been wide-ranging. But while COVID-19 has slowed us down, we will never stop.
We caught up with Dr Amanda Cross and Dr Becki Lee about how COVID-19 has impacted their work, and what the next few months looks like for them.
Dr Amanda Cross: “We’ve managed to continue to be very productive, I’m very proud of my team”
Dr Amanda Cross is a professor in cancer epidemiology and leads a group focused on bowel cancer screening and prevention at Imperial College London. Her team runs multiple large observational studies and trials, primarily looking at cancer screening and surveillance.
Unlike some researchers, Cross’ current work isn’t based in a lab, and for this she considers her team lucky to be to be able to continue relatively unaffected.
“When the lockdown started, we happened to be in a period where we weren’t actively recruiting to a study. So in that regard, it hasn’t messed up a study in the middle.”
The onset of the pandemic has by no means left them with nothing to do. “Everyone has really stepped up and been able to get on with their work,” says Cross. “We’ve managed to continue to be very productive, I’m very proud of my team.”
But while the team has been able to carry on with data collection and analysis for their existing studies, other vital work has had to be put on hold.
In England, bowel cancer screening is available to people aged 60-74, aiming to detect the early signs of bowel cancer in people without any symptoms. But it’s gone through some changes recently, when the traditional test for bowel cancer in the national screening programme was replaced by a new Faecal Immunochemical Test (FIT). FIT detects and quantifies the amount of human blood in a sample of poo, with a positive test suggesting gastrointestinal bleeding, a common sign of bowel cancer.
But while FIT has been rolled out in multiple countries, including England, Wales and Scotland, the threshold for what’s considered a positive result can be different in each country.
Cross and her team were about to begin a 10-year trial embedded in this screening program to see how many more cases of bowel cancer could be detected earlier by lowering the threshold for a positive FIT test. They had been granted funding in January, and were due to start the study in April.
“The purpose of this study is to look at how many more cancers we can detect, if we apply a much lower threshold and how cost-effective that would be.”
But just as the study was about to start, the COVID-19 outbreak began and the bowel cancer screening programme was effectively paused, with FIT kits not being sent out.
And until screening is fully back up and running, the team are left waiting.
“If the screening programme aren’t sending out their stool tests, we can’t recruit either,” Cross explains.
The team has used the time to get as prepared as possible with the paperwork and approvals behind the study. “But all of those committees are inundated with COVID-related proposals. And so,not suprisingly, anything non-COVID is getting pushed down the queue.
There is a definite feeling of frustration regarding the impact of COVID-19 on the screening programme itself and on research associated with screening.
“Thankfully, screening is resuming, and we hope to be able to get started with our study as soon as the screening programme reaches some level of normality” says Cross. “But the more delays we have, the longer it is before we have data that can help inform the national screening programme”.
Dr Becki Lee: “It has really massively changed my whole life”
For researchers who are also clinicians, the pandemic has left no area of their work unaffected.
Dr Becki Lee is a clinician scientist who is completing a year-long project at The Francis Crick Institute, researching melanoma in the liver.
Lee had been working as a cancer doctor at The Christie in Manchester before she moved to London in December 2019. A few months into her work in the capital, Becki, like the rest of us, began to witness the pandemic unfolding.
“I was quite aware of COVID-19 when we were starting to get more cases. So I emailed The Christie, fairly early actually, to check what they wanted to do and to see whether I was going to be needed.”
The situation developed rapidly, and there was a great demand for healthcare professionals to return to clinical work. “I had about a week or two’s notice and I moved everything from London back to Manchester. It has really massively changed my whole life.”
Working as a registrar again, Lee has also had to adapt to an entirely new way of working. “Back in hospital we’re doing things like telephone clinics, which has been a completely new thing that we’ve ended up undertaking to try and reduce the number of physical visits”.
Lee describes how phone calls are beneficial for some patients, who have trouble travelling. But for other, more sensitive conversations, talking on the phone can be very difficult.
Returning to the front-line of the pandemic meant that Lee had to leave her research project very suddenly, just as the Crick itself was temporarily closing. “I was at a bit of an unfortunate stage in terms of it was quite early in the project, I’d only really just started. So I was quite pleased with the progress I had made, but I didn’t really have loads of data to analyse at home.”
Because of the stage Lee left her research project, and how busy she has been working at the hospital, Lee has not had a chance to continue with any of her laboratory research from home.
But that’s beginning to change. As the number of COVID-19 cases continues to remain low, and lockdown measures continue to ease, Lee is looking to return to the Crick in August. “I’m hoping that I’ll be able to kind of pick up my research back where I paused it completely,” says Lee. “But I guess it will be a few weeks before I can properly get back up and running, because it takes a while to grow up your cells and get experiments set up”.
Lee has also been involved in a number of clinical trials that have been impacted by COVID-19.
One trial has been forced to halt recruitment of patients. “It’s such a shame because with trials you do feel like you’re gaining momentum with recruitment and then just to shut all that down is quite a big deal”.
And it’s not just recruitment that has been affected. Lee is also setting up another trial funded by Cancer Research UK at the minute. “It’s amazing and we’re massively grateful for the support.”
The trial aims to use blood tests to monitor people with early stage melanoma after surgery. “If we detect circulating tumour DNA in the samples, we will either keep the person on standard care or treat them early with immunotherapy. And the question is whether early treatment with immunotherapy improves survival.”
Lee and the team had been keen to collect and process additional samples during the trial, which would allow them to learn more about melanoma relapse and response to treatment. But that application has been held up by COVID-19.
“We’d put in a sample collection grant, and it was at that final stage. And it had already had good peer review, so we were quite hopeful.” The grant was about to go through the final stages before it could be accepted just as COVID hit, but Lee says the decision has been delayed now until May next year.
Lee describes how they’re in a state of limbo, and currently the team are planning on opening the trial without knowing whether they’ll get the grant for additional sample collection.
It’s been a busy period for Lee, but she’s looking forward to getting back in the lab. “I had a model set up in mice, so probably the first thing I’ll do is get that set up again and start to get some data, which will be exciting. Hopefully I can understand melanoma in the liver better so we can improve treatment in the future”
COVID-19 has slowed us down, but we will never stop.
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